1801893367 NPI number — DR. POLLY E LEONARD D.O.

Table of content: DR. POLLY E LEONARD D.O. (NPI 1801893367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801893367 NPI number — DR. POLLY E LEONARD D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEONARD
Provider First Name:
POLLY
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1801893367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
390 TOLL GATE RD STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-4326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-732-2031
Provider Business Mailing Address Fax Number:
888-948-3254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
390 TOLLGATE ROAD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-732-2031
Provider Business Practice Location Address Fax Number:
888-948-3254
Provider Enumeration Date:
06/30/2005

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: 204D00000X , with the licence number:  DO00496 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: DO00496 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1972746550 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27623 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 405246 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9002762 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0100985 . This is a "UNITED HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 710678 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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