Provider Demographics
NPI:1770599474
Name:TEEPLE, LESLIE ANN (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:TEEPLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1030 NEW HOLLAND AVE BLDG 12A
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5690
Mailing Address - Country:US
Mailing Address - Phone:610-857-6639
Mailing Address - Fax:610-857-6649
Practice Address - Street 1:950 S OCTORARA TRL
Practice Address - Street 2:
Practice Address - City:PARKESBURG
Practice Address - State:PA
Practice Address - Zip Code:19365-2100
Practice Address - Country:US
Practice Address - Phone:610-857-6639
Practice Address - Fax:610-857-6649
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037591E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E64952Medicare UPIN
CA136285OtherSTATE MEDICAL LICENSE
E64952Medicare UPIN