Provider Demographics
NPI:1720071285
Name:WINTERS, LESLIE ABIGAIL (DO)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ABIGAIL
Last Name:WINTERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-1334
Mailing Address - Country:US
Mailing Address - Phone:304-793-2274
Mailing Address - Fax:304-793-2275
Practice Address - Street 1:202 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-1334
Practice Address - Country:US
Practice Address - Phone:304-793-2274
Practice Address - Fax:304-793-2275
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2120710OtherCOVENTRY
58714OtherUNICARE WV MEDICAID HMO
7836272OtherAETNA
WVP00403032OtherRAILROAD MEDICARE
WV1806539000Medicaid
WV30778100OtherFEDERAL BLACK LUNG
440112OtherCARELINK
WV001723685OtherBCBS MOUNTAIN STATE
WV2120710OtherCOVENTRY
WV30778100OtherFEDERAL BLACK LUNG