Basic Information
| Provider Information | |||||||||
| NPI: | 1528033065 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAX | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 TER HEUN DR | ||||||||
| Address2: | FALMOUTH HOSPITAL, DEPT. OF PATHOLOGY | ||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025402503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084573536 | ||||||||
| FaxNumber: | 5084573641 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 TER HEUN DR | ||||||||
| Address2: | FALMOUTH HOSPITAL, DEPT. OF PATHOLOGY | ||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025402503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084573536 | ||||||||
| FaxNumber: | 5084573641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2006 | ||||||||
| LastUpdateDate: | 02/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 215994 | MA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0179477 | 05 | MA | MEDICAID | 220032798 | 01 | MA | RAILROAD MEDICARE | OTHER | J25415 | 01 | MA | BCBS MA | OTHER | 351121 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 600372 | 01 | MA | HARVARD PILGRIM | OTHER |