Provider Demographics
NPI:1588622393
Name:LESHIN, BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:LESHIN
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 1:1450 PROFESSIONAL PARK DR
Mailing Address - Street 2:STE 150
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1300
Mailing Address - Country:US
Mailing Address - Phone:336-724-2434
Mailing Address - Fax:336-724-6123
Practice Address - Street 1:1450 PROFESSIONAL PARK DR
Practice Address - Street 2:STE 150
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-724-2434
Practice Address - Fax:336-724-6123
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30199207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011WPMedicaid
NC89011WPMedicaid
NC2081988AMedicare ID - Type Unspecified