Provider Demographics
NPI:1518286061
Name:CLARK, LESLIE HORN (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:HORN
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:FINTEL
Other - Last Name:HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:DEPARTMENT OB/GYN, CB# 7570
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:919-966-5671
Mailing Address - Fax:919-843-6691
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:DEPARTMENT OB/GYN, CB# 7570
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:919-966-5671
Practice Address - Fax:919-843-6691
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC164935390200000X
NC2017-00702207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program