Provider Demographics
NPI:1639189756
Name:LEVINE, LEIGH ANN (DO)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANN
Last Name:LEVINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1642
Mailing Address - Country:US
Mailing Address - Phone:304-697-1396
Mailing Address - Fax:304-697-2086
Practice Address - Street 1:2908 AUBURN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-2715
Practice Address - Country:US
Practice Address - Phone:304-781-5800
Practice Address - Fax:304-781-5804
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1000569001Medicaid
WVLE4067141Medicare ID - Type Unspecified
H54805Medicare UPIN