Provider Demographics
NPI:1639156367
Name:LEONARD, ERIC LAWARENCE (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LAWARENCE
Last Name:LEONARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:RADIOLOGY INC
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25712-0910
Mailing Address - Country:US
Mailing Address - Phone:304-522-1550
Mailing Address - Fax:304-522-1073
Practice Address - Street 1:5221 US RT 60 E
Practice Address - Street 2:RADIOLOGY INC
Practice Address - City:HUNTIGTON
Practice Address - State:WV
Practice Address - Zip Code:25705
Practice Address - Country:US
Practice Address - Phone:304-522-1550
Practice Address - Fax:304-522-0704
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY372582085R0202X
OH35.0810642085R0202X
WV208952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV300130252OtherRR MEDICARE (WV)
7393619OtherAETNA
OH000000196556OtherUNISON
001718782OtherMTN STATE BC BS
WV1000922000Medicaid
KY50007266OtherPASSPORT
OH2322598Medicaid
KYP00766037OtherRR MEDICARE (KY)
WV55049337600OtherWORKMANS COMP
KY6405101400Medicaid
WV1000922000Medicaid
OH000000196556OtherUNISON
KY0683118Medicare PIN
WV4080601Medicare PIN