Provider Demographics
NPI:1407168842
Name:LESLIE, MARTHA LOUISE (MD, FACP)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:LOUISE
Last Name:LESLIE
Suffix:
Gender:F
Credentials:MD, FACP
Other - Prefix:MISS
Other - First Name:MARTHA
Other - Middle Name:LOUISE
Other - Last Name:LESLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, FACP
Mailing Address - Street 1:HOFZICHTLAAN 10
Mailing Address - Street 2:
Mailing Address - City:THE HAGUE
Mailing Address - State:NL
Mailing Address - Zip Code:2594CB
Mailing Address - Country:NL
Mailing Address - Phone:0113170-419-0141
Mailing Address - Fax:0113170-419-0141
Practice Address - Street 1:HOFZICHTLAAN 10
Practice Address - Street 2:
Practice Address - City:THE HAGUE
Practice Address - State:NL
Practice Address - Zip Code:2594CB
Practice Address - Country:NL
Practice Address - Phone:0113170-419-0141
Practice Address - Fax:0113170-419-0141
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68840207R00000X
WI39586-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine