Provider Demographics
NPI:1235339607
Name:LEAHY, ERIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:J
Last Name:LEAHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT STREET
Mailing Address - Street 2:2ND FL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:759 CHESTNUT ST
Practice Address - Street 2:S2668
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1619
Practice Address - Country:US
Practice Address - Phone:413-794-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA243564207RG0300X
WI52576207RG0300X
TNMD48447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1235339607OtherFALLON COMMUNITY HEALTH PLAN
MA110563OtherBMC HEALTHNET
MA243564OtherCONNECTICARE
MA6490805OtherCIGNA
MA110086718AMedicaid
MA243564OtherAETNA
MAAA186140OtherHARVARD PILGRIM HEALTH PLAN