Provider Demographics
NPI:1295997682
Name:FORT-BARRIE, LESLIE (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:FORT-BARRIE
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 1:3010 TRENWEST DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3208
Mailing Address - Country:US
Mailing Address - Phone:336-718-5844
Mailing Address - Fax:336-978-5298
Practice Address - Street 1:3010 TRENWEST DRIVE
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3208
Practice Address - Country:US
Practice Address - Phone:336-718-5844
Practice Address - Fax:336-978-5298
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-002042085R0202X
MS198472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology