Basic Information
| Provider Information | |||||||||
| NPI: | 1235122417 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEILIG | ||||||||
| FirstName: | LESLYE | ||||||||
| MiddleName: | ROBIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MAPLE AVE STE 1 | ||||||||
| Address2: | |||||||||
| City: | GREAT BARRINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012301965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135284047 | ||||||||
| FaxNumber: | 4135283407 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MAPLE AVE STE 1 | ||||||||
| Address2: | |||||||||
| City: | GREAT BARRINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012301965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135284047 | ||||||||
| FaxNumber: | 4135283407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 08/27/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 073130 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 26955 | 01 | MVP | OTHER | 3067432 | 05 | MA | MEDICAID | 817410 | 01 | UNITED HEALTH | OTHER | P625198 | 01 | OXFORD | OTHER | 000000020948 | 01 | BMC HEALTHNET | OTHER | 00979915 | 01 | NY MEDICAID | OTHER | 10275301 | 01 | CIGNA | OTHER | MA0479 | 01 | HEALTHNET OF THE NE, INC. | OTHER | 073130 | 01 | CTCARE | OTHER | 10029273 | 01 | CDPHP | OTHER | 28100 | 01 | CHILDRENS MEDICAL | OTHER | 12991 | 01 | HEALTH NEW ENGLAND | OTHER | 073130 | 01 | TUFTS HEALTH PLAN | OTHER | A64448 | 01 | HARVARD PILGRIM HEALTH | OTHER | J10138 | 01 | BCBS OF MA | OTHER |