Provider Demographics
NPI:1356329833
Name:GO, LESLIE S (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:S
Last Name:GO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 HATFIELD ST APT C
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-1544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:421 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:MA
Practice Address - Zip Code:01053-9764
Practice Address - Country:US
Practice Address - Phone:413-584-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156132208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-2488084OtherUNICARE/GIC
MA22766OtherHEALTH NEW ENGLAND
MD04-2488084OtherNORTHEAST HEALTH DIRECT
MA807847OtherHARVARD PILGRIM
MAJ18734OtherBCBSMA
MA3178757Medicaid
MA04-2488084OtherGREAT-WEST
MA04-2488084OtherNORTHEAST HEALTHCARE ALLI
MA2518317OtherAETNA
MA000000006681OtherBMC
MA156132OtherCONNECTICARE
MA04-2488084OtherNORTH AMERICAN PREFERRED
MA102463OtherCIGNA
MD156132OtherTUFTS
MA04-2488084OtherPLAN VISTA