Provider Demographics
NPI:1780754200
Name:RAY, LESLIE A (AA)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:RAY
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:A
Other - Last Name:SCHAMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:3605 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5203
Mailing Address - Country:US
Mailing Address - Phone:216-286-6260
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67-000124367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000515974OtherANTHEM
OHP00445362OtherRAILROAD MEDICARE
OH9209072OtherAETNA
OH0583328OtherBCMH
OH000000232312OtherUNISON
OH2777642Medicaid
OHRA8238461Medicare PIN