Provider Demographics
NPI:1952747396
Name:MCELRATH, LESLEE RENEE (MD)
Entity type:Individual
Prefix:
First Name:LESLEE
Middle Name:RENEE
Last Name:MCELRATH
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 1:2855 W MARKET ST STE 204
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4034
Mailing Address - Country:US
Mailing Address - Phone:234-281-4384
Mailing Address - Fax:234-203-5011
Practice Address - Street 1:2855 W MARKET ST STE 204
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4034
Practice Address - Country:US
Practice Address - Phone:234-281-4384
Practice Address - Fax:234-203-5011
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134997207Q00000X
MDD0082710207QA0505X
OH35.132878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0289520Medicaid