Provider Demographics
NPI:1689696452
Name:LESLIE, BRUCE ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ROBERT
Last Name:LESLIE
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 1:2501 M ST NW UNIT 210
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1314
Mailing Address - Country:US
Mailing Address - Phone:504-931-3484
Mailing Address - Fax:609-225-5224
Practice Address - Street 1:2501 M ST NW UNIT 210
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1314
Practice Address - Country:US
Practice Address - Phone:504-931-3484
Practice Address - Fax:609-225-5224
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133449207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1332127Medicaid
LA1332127Medicaid
A60138Medicare UPIN