Provider Demographics
NPI:1417954322
Name:LEONARD, KAREN S (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:S
Last Name:LEONARD
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 1:111 COLCHESTER AVE
Mailing Address - Street 2:265SM5
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-5321
Mailing Address - Fax:802-847-8064
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:265SM5
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-5321
Practice Address - Fax:802-847-8064
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010554208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009554Medicaid
VT00068258OtherBLUECROSSBLUESHIELD
4142325OtherMVP HEALTHCARE
9639268OtherCIGNA
VTVN3172Medicare ID - Type Unspecified
4142325OtherMVP HEALTHCARE