Provider Demographics
NPI:1356333769
Name:LEDER, MARC SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:SCOTT
Last Name:LEDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CHILDREN'S DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:614-722-2000
Mailing Address - Fax:614-722-4380
Practice Address - Street 1:4363 ALL SEASONS DR STE 100
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-2050
Practice Address - Country:US
Practice Address - Phone:614-355-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350648442080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0920981Medicaid
WV6701228000OtherMEDICAID
KY64960651OtherMEDICAID
KY64960651OtherMEDICAID
G03377Medicare UPIN