Provider Demographics
NPI:1760468771
Name:WEBSTER, LESLIE TILLOTSON III (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:TILLOTSON
Last Name:WEBSTER
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 33369
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28233-3369
Mailing Address - Country:US
Mailing Address - Phone:704-364-8100
Mailing Address - Fax:704-365-2073
Practice Address - Street 1:10512 PARK ROAD
Practice Address - Street 2:SUITE 101 SURGICAL SPECIALISTS OF CHARLOTTE PA
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210
Practice Address - Country:US
Practice Address - Phone:704-542-3631
Practice Address - Fax:704-542-3646
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2023-08-27
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Provider Licenses
StateLicense IDTaxonomies
NC997019208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC291222AMedicaid
NC891222AMedicaid
2279347Medicare PIN
NC891222AMedicaid
NCH02766Medicare UPIN