Provider Demographics
NPI:1346319092
Name:JASON E LEEDY MD LLC
Entity Type:Organization
Organization Name:JASON E LEEDY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-461-6100
Mailing Address - Street 1:2060 LANDER RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4100
Mailing Address - Country:US
Mailing Address - Phone:440-461-6100
Mailing Address - Fax:440-461-1440
Practice Address - Street 1:2060 LANDER RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4100
Practice Address - Country:US
Practice Address - Phone:440-461-6100
Practice Address - Fax:440-461-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350852662086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2731468Medicaid
OH2731468Medicaid
OHDD9560Medicare PIN