Individual
DR. LESLIE GLEN MASSOGLIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4845 SAFARI CT N, EAGAN, MN 55122-2617
(507) 461-3813
(952) 431-5334
Mailing address
4845 SAFARI CT N, EAGAN, MN 55122-2617
(507) 461-3813
(651) 305-0595
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
43602
MN
207QA0401X
Addiction Medicine (Family Medicine) Physician
43602
MN
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
43602
MN
208VP0000X
Pain Medicine Physician
43602
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0107062, 39-09161
MEDICA
MN
01
—
080172550
MEDICARE RAILROAD
MN
01
—
117R2BA, 015K3BA
BCBS
MN
01
—
140964
MNCARE-U
MN
01
—
20153
SVHP
MN
01
—
363606405
CHAMPUS
MN
05
—
564110100
—
MN
01
—
HP33926
HEALTH PARTNERS
MN
01
—
NA9501028427
PREFERRED ONE
MN
Enumeration date
12/14/2005
Last updated
02/27/2019
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