Provider Demographics
NPI:1205892858
Name:TRIPP, LESLIE N (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:N
Last Name:TRIPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HEALTHCARE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3747
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-282-9180
Practice Address - Street 1:13 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1804
Practice Address - Country:US
Practice Address - Phone:207-283-8800
Practice Address - Fax:207-286-9853
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEM10003001OtherCIGNA
MEB86263OtherHARVARD PILGRIM
ME017207OtherANTHEM
ME1042275OtherAETNA
ME017207OtherANTHEM
MEMM0064Medicare ID - Type Unspecified