Provider Demographics
NPI:1376769307
Name:PLOCKI, LEONARD KEITH (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:KEITH
Last Name:PLOCKI
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:PO BOX 1002
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050
Mailing Address - Country:US
Mailing Address - Phone:740-393-3455
Mailing Address - Fax:740-399-3134
Practice Address - Street 1:1330 COSHOCTON ROAD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-393-9770
Practice Address - Fax:740-399-3134
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059747207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0785646Medicaid
OH0785646Medicaid
OHPL0667256Medicare PIN
E57713Medicare UPIN