1104113190 NPI number — DR. JULIE D. LEYZOREK HARE MD

Table of content: DR. JULIE D. LEYZOREK HARE MD (NPI 1104113190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104113190 NPI number — DR. JULIE D. LEYZOREK HARE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEYZOREK HARE
Provider First Name:
JULIE
Provider Middle Name:
D.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARE
Provider Other First Name:
JULIE
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104113190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
815 7TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLINTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24954-1212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-478-3567
Provider Business Mailing Address Fax Number:
413-200-2668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 7TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLINTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24954-1212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-478-3567
Provider Business Practice Location Address Fax Number:
413-200-2668
Provider Enumeration Date:
06/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  25895 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 207Q00000X . This is a "FAMILY MEDICINE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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