1447259007 NPI number — LESLIE CARROLL MEYERS-JOSEPH MD

Table of content: LESLIE CARROLL MEYERS-JOSEPH MD (NPI 1447259007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447259007 NPI number — LESLIE CARROLL MEYERS-JOSEPH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEYERS-JOSEPH
Provider First Name:
LESLIE
Provider Middle Name:
CARROLL
Provider Name Prefix Text:
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:
MEYERS
Provider Other First Name:
LESLIE
Provider Other Middle Name:
CARROLL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447259007
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 N CLEVELAND AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
WESTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43082-9688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-891-9505
Provider Business Mailing Address Fax Number:
614-891-6416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 N CLEVELAND AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WESTERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43082-9688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-891-9505
Provider Business Practice Location Address Fax Number:
614-891-6416
Provider Enumeration Date:
07/18/2005

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: 208000000X , with the licence number:  35129681 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0203427 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com