Provider Demographics
NPI:1861496606
Name:DOOLITTLE, LESLIE D (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:D
Last Name:DOOLITTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5813
Mailing Address - Country:US
Mailing Address - Phone:207-873-5437
Mailing Address - Fax:207-861-5448
Practice Address - Street 1:159 SILVER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5813
Practice Address - Country:US
Practice Address - Phone:207-873-5437
Practice Address - Fax:207-861-5448
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012115208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME290560099Medicaid
ME290560099Medicaid