Provider Demographics
NPI:1356394779
Name:BROWN, LESLIE A (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:225 E CITY AVE
Mailing Address - Street 2:#101
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1704
Mailing Address - Country:US
Mailing Address - Phone:610-664-4616
Mailing Address - Fax:610-664-3122
Practice Address - Street 1:225 E CITY AVE
Practice Address - Street 2:#101
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1704
Practice Address - Country:US
Practice Address - Phone:610-664-4616
Practice Address - Fax:610-664-3122
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD043178E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0124652401Medicaid
PAE78183Medicare UPIN
PA662188Medicare ID - Type Unspecified