Provider Demographics
NPI:1285660753
Name:SIMPSON-TAROKH, LEANN RAE (DO)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:RAE
Last Name:SIMPSON-TAROKH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SANFORD HEALTH AND REHABILITATION
Mailing Address - Street 2:2702 FARRELL RD
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330
Mailing Address - Country:US
Mailing Address - Phone:919-776-9602
Mailing Address - Fax:
Practice Address - Street 1:2702 FARRELL RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-6505
Practice Address - Country:US
Practice Address - Phone:919-776-9602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246312207Q00000X
NC2015-02200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03023118Medicaid
NYRB8988Medicare PIN