Provider Demographics
NPI:1841260205
Name:WEST, LESLEY S (MD)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:S
Last Name:WEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:35 MEDICAL CENTER PARKWAY, SUITE 101
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-430-4321
Practice Address - Fax:207-430-4320
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEMD16046207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME304000099Medicaid
MEP01122825Medicare PIN
MEMM9731Medicare PIN
ME304000099Medicaid
MEP01062278Medicare PIN
MEMM973101Medicare PIN
MEMM973102Medicare PIN
MEP01079438Medicare PIN
MEMM973103Medicare PIN
MEP01079435Medicare PIN