Provider Demographics
NPI:1801885389
Name:TAGUBA-MADRID, LESLIE CATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:CATHERINE
Last Name:TAGUBA-MADRID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 ROUTE 37 W
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-4973
Mailing Address - Country:US
Mailing Address - Phone:732-736-1000
Mailing Address - Fax:732-736-8811
Practice Address - Street 1:1163 ROUTE 37 W
Practice Address - Street 2:SUITE A-1
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4973
Practice Address - Country:US
Practice Address - Phone:732-736-1000
Practice Address - Fax:732-736-8811
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09207900207RE0101X
VA0101239833207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34156600Medicaid
120500031Medicare ID - Type Unspecified
H54171Medicare UPIN
WI34156600Medicaid