Provider Demographics
NPI:1457595399
Name:PATCH, LESLIE WEI (MD)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:WEI
Last Name:PATCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:WEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1562
Mailing Address - Country:US
Mailing Address - Phone:740-441-1949
Mailing Address - Fax:740-446-5982
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631
Practice Address - Country:US
Practice Address - Phone:855-446-5937
Practice Address - Fax:740-446-8683
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279820207W00000X, 207WX0200X, 2082S0099X
OH35.132596207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
158752353Medicare PIN