Individual
LESLIE R ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON-SALEM, NC 27157
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
2006-01475
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143NE
BCBS
—
05
—
1790861128
—
VA
01
—
192031
MEDCOST
—
05
—
3810010756
—
WV
05
—
5905535
—
NC
01
—
7173908
AETNA
—
01
—
808453
PARTNERS
—
05
—
Q01785
—
SC
Enumeration date
10/27/2006
Last updated
05/07/2008
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