Provider Demographics
NPI:1477698702
Name:CULLEN, LEAH OSEAS (MD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:OSEAS
Last Name:CULLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LEAH
Other - Middle Name:RUTH
Other - Last Name:OSEAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:85 BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5409
Mailing Address - Country:US
Mailing Address - Phone:401-475-0914
Mailing Address - Fax:401-475-4797
Practice Address - Street 1:85 BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5409
Practice Address - Country:US
Practice Address - Phone:401-475-0914
Practice Address - Fax:401-475-4797
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD061962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI20018-1OtherBLUECROSS & BLUE SHIELD
RI9020018Medicaid
RI409231OtherBLUECHIP PROVIDER ID
RI269020018Medicare ID - Type Unspecified
RIC90560Medicare UPIN