Provider Demographics
NPI:1598719890
Name:LEITH, JOSEPH R (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:LEITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:8770 OHIO RIVER RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-1918
Practice Address - Country:US
Practice Address - Phone:740-574-9090
Practice Address - Fax:740-356-4180
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY40139207X00000X
OH35-083254207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY40139OtherKENTUCKY MEDICAL LICENSE
OH505145374-00OtherBWC
OH2636893Medicaid
205145374027OtherCARESOURCE
KY613050500OtherDEPARTMENT OF LABOR
7207794OtherAETNA
00000501050OtherANTHEM
KY64126303Medicaid
KYP00401805OtherRAILROAD MEDICARE
KYP00401805OtherRAILROAD MEDICARE