1639156367 NPI number — ERIC LAWARENCE LEONARD MD

Table of content: (NPI 1992329528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639156367 NPI number — ERIC LAWARENCE LEONARD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEONARD
Provider First Name:
ERIC
Provider Middle Name:
LAWARENCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639156367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 910
Provider Second Line Business Mailing Address:
RADIOLOGY INC
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25712-0910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-522-1550
Provider Business Mailing Address Fax Number:
304-522-1073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3448 US ROUTE 60
Provider Second Line Business Practice Location Address:
RADIOLOGY INC
Provider Business Practice Location Address City Name:
HUNTIGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25705-2906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-1550
Provider Business Practice Location Address Fax Number:
304-522-0704
Provider Enumeration Date:
12/23/2005

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: 2085R0202X , with the licence number:  37258 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 35.081064 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 20895 , 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: 50007266 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6405101400 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7393619 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000196556 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 001718782 . This is a "MTN STATE BC BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300130252 . This is a "RR MEDICARE (WV)" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2322598 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000922000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55049337600 . This is a "WORKMANS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: P00766037 . This is a "RR MEDICARE (KY)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 106201200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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