Individual
LISA SUZANNE LESLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-0288
Mailing address
12 SARGENT AVE UNIT 2, SOMERVILLE, MA 02145-2914
(585) 469-6706
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
1013372
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/20/2019
Last updated
07/26/2023
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