Provider Demographics
NPI:1508964297
Name:SMITH, LESLIE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:184 IRISH WALK RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-7956
Mailing Address - Country:US
Mailing Address - Phone:828-557-1031
Mailing Address - Fax:
Practice Address - Street 1:400 SHADOWLINE DR STE 201B
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5022
Practice Address - Country:US
Practice Address - Phone:828-832-8300
Practice Address - Fax:828-832-8303
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00426208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH97730Medicare UPIN
NC2041005Medicare ID - Type Unspecified