Provider Demographics
NPI:1962662767
Name:CARNEY, LESLI MARIE (MD)
Entity type:Individual
Prefix:MRS
First Name:LESLI
Middle Name:MARIE
Last Name:CARNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLI
Other - Middle Name:MARIE
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5279 EVERGREEN ROAD
Mailing Address - Street 2:
Mailing Address - City:FRAZIERS BOTTOM
Mailing Address - State:WV
Mailing Address - Zip Code:25082
Mailing Address - Country:US
Mailing Address - Phone:304-993-7725
Mailing Address - Fax:
Practice Address - Street 1:5279 EVERGREEN ROAD
Practice Address - Street 2:
Practice Address - City:FRAZIERS BOTTOM
Practice Address - State:WV
Practice Address - Zip Code:25082
Practice Address - Country:US
Practice Address - Phone:304-993-7725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WV27439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program