Provider Demographics
NPI:1720372683
Name:FARRELL, LESLIE MAGIDA (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MAGIDA
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:DANIELLE
Other - Last Name:MAGIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:MLC 5021
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-803-8092
Mailing Address - Fax:503-803-9245
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:MLC 5021
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-803-8092
Practice Address - Fax:503-803-9245
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255990208000000X
DCMD043223208000000X
OH35.131135208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics