Provider Demographics
NPI:1417393273
Name:LEIGH, LYVIA Y (MD)
Entity Type:Individual
Prefix:
First Name:LYVIA
Middle Name:Y
Last Name:LEIGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 KINGS HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1772
Mailing Address - Country:US
Mailing Address - Phone:302-643-4123
Mailing Address - Fax:888-979-9165
Practice Address - Street 1:750 KINGS HWY STE 102
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1772
Practice Address - Country:US
Practice Address - Phone:302-643-4123
Practice Address - Fax:888-979-9165
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD465089207K00000X, 207RA0201X
390200000X
DEC1-0024361207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035216590001Medicaid
DE250692082Medicaid