Provider Demographics
NPI:1487890331
Name:KOLE, LESLIE ANN (PA-C)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANN
Last Name:KOLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12528 CARRY BACK PL
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMA
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:240-631-1568
Mailing Address - Fax:
Practice Address - Street 1:9309 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:240-631-1568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-24
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant