Provider Demographics
NPI:1598810483
Name:GRIFFIN, LESLIE CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:CAROL
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:7141 SECURITY BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-1811
Practice Address - Country:US
Practice Address - Phone:443-663-6000
Practice Address - Fax:443-663-6172
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD344572085R0202X
VA01011028412085R0202X
DCMD158572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
K679F986Medicare ID - Type Unspecified
018181K92Medicare ID - Type Unspecified
S883M051Medicare ID - Type Unspecified
D77872Medicare UPIN