Ellis, Leslie R
Ellis, Leslie R is an individual health care provider with primary practice located at Medical Center Blvd , Winston-Salem NC 27157. She recently has only one registered license in Allopathic & Osteopathic Physicians / Medical Oncology, which is considered as her primary health care specialty. Ellis, Leslie R can be contacted via phone (336) 716-2255.Contact Information
Primary practice address
Medical Center Blvd
Winston-Salem NC 27157
Phone: (336) 716-2255
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Medical Oncology | 207RX0202X | 2006-01475 | North Carolina |
Profile Details
| NPI number | 1790861128 |
|---|---|
| LBN Legal business name | Ellis, Leslie R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 27th, 2006 |
| Last updated | May 7th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790861128 | NPPES |
| South Carolina | MEDICAID | Q01785 | |
| South Carolina | MEDICAID | 5905535 | |
| South Carolina | Other | 192031 | |
| South Carolina | Other | 808453 | |
| South Carolina | Other | 7173908 | |
| South Carolina | Other | 143NE | |
| South Carolina | MEDICAID | 1790861128 | |
| South Carolina | MEDICAID | 3810010756 |
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