Provider Demographics
NPI:1194870790
Name:HAO, LESLIE FAN (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:FAN
Last Name:HAO
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 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE #1455
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-656-8630
Mailing Address - Fax:301-656-8631
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE #1455
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-656-8630
Practice Address - Fax:301-656-8631
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056720207Y00000X
DCMD32660207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0W54TPOtherBLUE CROSS
0W54TPOtherBLUE CROSS