Provider Demographics
NPI:1568521078
Name:SMITH, LESLIE D (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:SMITH
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:300 STAFFORD ST
Mailing Address - Street 2:360
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3581
Mailing Address - Country:US
Mailing Address - Phone:413-734-8440
Mailing Address - Fax:413-731-6703
Practice Address - Street 1:300 STAFFORD ST
Practice Address - Street 2:SUITE 360
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3581
Practice Address - Country:US
Practice Address - Phone:413-734-8440
Practice Address - Fax:413-731-6703
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1498363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant