Provider Demographics
NPI:1205846045
Name:LEFTON, DOUGLAS L (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:LEFTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3702
Mailing Address - Country:US
Mailing Address - Phone:330-836-9721
Mailing Address - Fax:330-836-9627
Practice Address - Street 1:50 N MILLER RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3702
Practice Address - Country:US
Practice Address - Phone:330-836-9721
Practice Address - Fax:330-836-9627
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH080165227OtherRAILROAD MEDICARE
OH000000140419OtherANTHEM
OH2143059Medicaid
OH080165227OtherRAILROAD MEDICARE
OH0872231Medicare PIN