Provider Demographics
NPI:1972584431
Name:LESLIE, JOHN W JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:LESLIE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 VINYARD AVE
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-1327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 LAMB CIR
Practice Address - Street 2:SUITE 7-700B
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6344
Practice Address - Country:US
Practice Address - Phone:540-731-7450
Practice Address - Fax:540-639-4139
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-044833207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010157625Medicaid
VA007663C40Medicare ID - Type Unspecified
VA018052C18Medicare PIN
VA007663C40Medicare PIN
VAF67300Medicare UPIN
VAP00232311Medicare PIN