Provider Demographics
NPI:1629053400
Name:LESLIE, KAREN E (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:E
Last Name:LESLIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:E
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:6 COLLEGE STREET
Mailing Address - City:DUE WEST
Mailing Address - State:SC
Mailing Address - Zip Code:29639-0638
Mailing Address - Country:US
Mailing Address - Phone:864-379-2345
Mailing Address - Fax:864-379-3228
Practice Address - Street 1:6 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:DUE WEST
Practice Address - State:SC
Practice Address - Zip Code:29639-9554
Practice Address - Country:US
Practice Address - Phone:864-379-2345
Practice Address - Fax:864-379-3228
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19266207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL20868Medicaid
SCG668243974Medicare ID - Type Unspecified
G66824Medicare UPIN