Provider Demographics
NPI:1780849281
Name:MCDOUGALL, LESLIE (DO)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MCDOUGALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 OLD GATESBURG RD
Mailing Address - Street 2:STE 100
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2290
Mailing Address - Country:US
Mailing Address - Phone:814-231-6868
Mailing Address - Fax:814-231-1581
Practice Address - Street 1:2121 OLD GATESBURG RD
Practice Address - Street 2:STE 100
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2290
Practice Address - Country:US
Practice Address - Phone:814-231-6868
Practice Address - Fax:814-231-1581
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0165622084N0400X, 2084N0600X
GA844112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology