1457595399 NPI number — MRS. LESLIE WEI PATCH M.D.

Table of content: MRS. LESLIE WEI PATCH M.D. (NPI 1457595399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457595399 NPI number — MRS. LESLIE WEI PATCH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATCH
Provider First Name:
LESLIE
Provider Middle Name:
WEI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEI
Provider Other First Name:
LESLIE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457595399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 JACKSON PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLIPOLIS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45631-1562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-441-1949
Provider Business Mailing Address Fax Number:
740-446-5982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 JACKSON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALLIPOLIS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-446-5937
Provider Business Practice Location Address Fax Number:
740-446-8683
Provider Enumeration Date:
04/22/2009

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: 207W00000X , with the licence number:  35.132596 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: 279820 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0099X , with the licence number: 279820 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0200X , with the licence number: 279820 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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