Provider Demographics
NPI:1851303002
Name:GAMACHE, LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:GAMACHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:CLAIRE
Other - Last Name:SALBENBLATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-228-1240
Mailing Address - Fax:303-228-1250
Practice Address - Street 1:1601 E 19TH AVE STE 4350
Practice Address - Street 2:SUITE 454
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1253
Practice Address - Country:US
Practice Address - Phone:303-228-1240
Practice Address - Fax:303-228-1250
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44771207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025716100Medicaid
WY1851303002Medicaid
KS200739320AMedicaid
NM50858360Medicaid
CO89438825Medicaid
COP00681959Medicare PIN
NE10025716100Medicaid
CO89438825Medicaid