Provider Demographics
NPI:1447259007
Name:MEYERS-JOSEPH, LESLIE CARROLL (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:CARROLL
Last Name:MEYERS-JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:CARROLL
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 N CLEVELAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9688
Mailing Address - Country:US
Mailing Address - Phone:614-891-9505
Mailing Address - Fax:614-891-6416
Practice Address - Street 1:540 N CLEVELAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9688
Practice Address - Country:US
Practice Address - Phone:614-891-9505
Practice Address - Fax:614-891-6416
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35129681208000000X
GA044540208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0203427Medicaid
OH0203427Medicaid