Provider Demographics
NPI:1568417228
Name:KINGSLOW, LESLIE WEBSTER (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:WEBSTER
Last Name:KINGSLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 LANCIA CT
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2202
Mailing Address - Country:US
Mailing Address - Phone:202-526-5491
Mailing Address - Fax:202-525-7679
Practice Address - Street 1:1160 VARNUM STREET
Practice Address - Street 2:SUITE 214
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017
Practice Address - Country:US
Practice Address - Phone:202-526-5491
Practice Address - Fax:202-526-7679
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD20182207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC015788W17Medicare ID - Type Unspecified
DCF23322Medicare UPIN