Provider Demographics
NPI:1700821816
Name:LEONIDA, SOPHIA V (MD)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:V
Last Name:LEONIDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2228 BLACK ROCK TPKE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3237
Mailing Address - Country:US
Mailing Address - Phone:203-375-9350
Mailing Address - Fax:203-375-8013
Practice Address - Street 1:2228 BLACK ROCK TPKE
Practice Address - Street 2:SUITE 211
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3237
Practice Address - Country:US
Practice Address - Phone:203-375-9350
Practice Address - Fax:203-375-8013
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT023160208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061152058OtherPHCS
CT0040556OtherU.S. HEALTH CARE
CT010023160CT05OtherBLUE CROSS BLUE SHIELD
CT061152058OtherHEALTH SOURCE
CT114485OtherPREFERRED ONE
CT2173536OtherAETNA
CT01023160OtherCIGNA HEALTH PLANS
CT114485OtherYALE PREFERRED HEALTH
CT061152058OtherHMO
CT061152058OtherUNITED HEALTH CARE
CT7530584100OtherCONNECTICARE
CT00123160400OtherBLUE CARE FAMILY PLAN
CT001231604Medicaid
CT061152058OtherCOMMERCIAL INSURANCE
CT061152058OtherHEALTH CHOICE
CT061152058OtherMED SPAN
CTZP060OtherOXFORD HEALTH PLAN
CT061152058OtherHEALTH CARE VALUEMANAGMET
CT00389RMedicare UPIN