Provider Demographics
NPI:1356371496
Name:BRANDWIN, LESLIE M (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:M
Last Name:BRANDWIN
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 1:5249 DUKE STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304
Mailing Address - Country:US
Mailing Address - Phone:703-658-2650
Mailing Address - Fax:703-658-2656
Practice Address - Street 1:7440 SPRING VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-4446
Practice Address - Country:US
Practice Address - Phone:703-923-4644
Practice Address - Fax:703-923-4625
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-022445207R00000X
VA0101022445207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1356371496OtherBCBS-VA
MD607055-01OtherBCBS OF MD
0001OtherBCBS-DC
0411220OtherEVERCARE
0001OtherBCBS-DC
VAA12576Medicare UPIN
VA110189986Medicare PIN