Provider Demographics
NPI:1598870198
Name:SIMMONS, LESLIE MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:MICHELLE
Last Name:SIMMONS
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 1:1111 SPRING ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4003
Mailing Address - Country:US
Mailing Address - Phone:301-585-0040
Mailing Address - Fax:301-565-8079
Practice Address - Street 1:1111 SPRING ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4003
Practice Address - Country:US
Practice Address - Phone:301-585-0040
Practice Address - Fax:301-565-8079
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050606207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD363791301Medicaid
MD462203OtherANTHEM
MD534927-06OtherBC/BSMD
MD0701253OtherUHC-COMMUNITY
2995340OtherAETNA HMO
DC0003OtherBC/BSDC
MD633196OtherMAMSI
MD08173OtherAMERIGROUP
4672749OtherAETNA PPO
DC0003OtherBC/BSDC