Provider Demographics
NPI:1477717700
Name:LEIGH ANN LEVINE, DO PLLC
Entity Type:Organization
Organization Name:LEIGH ANN LEVINE, DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-525-7471
Mailing Address - Street 1:2501 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1614
Mailing Address - Country:US
Mailing Address - Phone:304-525-7471
Mailing Address - Fax:304-525-6003
Practice Address - Street 1:2501 3RD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1614
Practice Address - Country:US
Practice Address - Phone:304-525-7471
Practice Address - Fax:304-525-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1000569001Medicaid
WVH54805Medicare UPIN