Provider Demographics
NPI:1295786382
Name:KOHMAN, LESLIE J (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:J
Last Name:KOHMAN
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 1:550 HARRISON ST
Mailing Address - Street 2:STE 330
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3188
Mailing Address - Country:US
Mailing Address - Phone:315-464-1800
Mailing Address - Fax:315-464-6252
Practice Address - Street 1:550 HARRISON ST
Practice Address - Street 2:STE 330
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3188
Practice Address - Country:US
Practice Address - Phone:315-464-1800
Practice Address - Fax:315-464-6252
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146214208G00000X, 2086H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086H0002XAllopathic & Osteopathic PhysiciansSurgeryHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00622151Medicaid
B82602Medicare UPIN
NY00622151Medicaid