Provider Demographics
NPI:1528033065
Name:MAX, LESLIE D (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:D
Last Name:MAX
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 TER HEUN DR
Mailing Address - Street 2:FALMOUTH HOSPITAL, DEPT. OF PATHOLOGY
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2503
Mailing Address - Country:US
Mailing Address - Phone:508-457-3536
Mailing Address - Fax:508-457-3641
Practice Address - Street 1:100 TER HEUN DR
Practice Address - Street 2:FALMOUTH HOSPITAL, DEPT. OF PATHOLOGY
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2503
Practice Address - Country:US
Practice Address - Phone:508-457-3536
Practice Address - Fax:508-457-3641
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2010-02-23
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Provider Licenses
StateLicense IDTaxonomies
MA215994207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0179477Medicaid
MA220032798OtherRAILROAD MEDICARE
MAJ25415OtherBCBS MA
MA351121OtherTUFTS HEALTH PLAN
MA600372OtherHARVARD PILGRIM
MA600372OtherHARVARD PILGRIM
MA220032798OtherRAILROAD MEDICARE