Provider Demographics
NPI:1003097403
Name:JOSEPH S. LEITHOLD, M.D., LLC
Entity Type:Organization
Organization Name:JOSEPH S. LEITHOLD, M.D., LLC
Other - Org Name:WOODCROFT FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LEITHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-427-9202
Mailing Address - Street 1:4235 INDIAN RIPPLE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3284
Mailing Address - Country:US
Mailing Address - Phone:937-427-9202
Mailing Address - Fax:937-427-9671
Practice Address - Street 1:4235 INDIAN RIPPLE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3284
Practice Address - Country:US
Practice Address - Phone:937-427-9202
Practice Address - Fax:937-427-9671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0248397Medicaid
OHDB1884OtherMEDICARE RR UPIN
OH080162406OtherMEDICARE RAILROAD
OHDB1884OtherMEDICARE RR UPIN#
OHDB1884OtherMEDICARE RR UPIN#
9310651Medicare PIN