Provider Demographics
NPI:1801805221
Name:ELDEIRY, LESLIE S (MD)
Entity type:Individual
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First Name:LESLIE
Middle Name:S
Last Name:ELDEIRY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:133 BROOKLINE AVE FL 9
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3904
Mailing Address - Country:US
Mailing Address - Phone:617-421-1380
Mailing Address - Fax:617-421-2707
Practice Address - Street 1:133 BROOKLINE AVE FL 9
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-1380
Practice Address - Fax:617-421-2707
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-02-10
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Provider Licenses
StateLicense IDTaxonomies
MA222194207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0033556OtherNEIGHBORHOOD HEALTH PLAN
MAAA16502OtherHARVARD PILGRIM
MA469784OtherTUFTS HEALTH PLAN
MA2088525Medicaid
MA8039502OtherCIGNA
MAJ27950OtherBLUE CROSS
MAAA16502OtherHARVARD PILGRIM
MA469784OtherTUFTS HEALTH PLAN