Provider Demographics
NPI:1710918487
Name:LEONHARDT, DOUGLAS ANDREW (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ANDREW
Last Name:LEONHARDT
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Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:800 IRVING AVE
Mailing Address - Street 2:TEAM RED PRIMARY CARE
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2716
Mailing Address - Country:US
Mailing Address - Phone:315-428-4828
Mailing Address - Fax:315-425-4827
Practice Address - Street 1:800 IRVING AVE
Practice Address - Street 2:TEAM RED PRIMARY CARE
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2716
Practice Address - Country:US
Practice Address - Phone:315-428-4828
Practice Address - Fax:315-425-4827
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY009044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA0353Medicare PIN
NYP82070Medicare UPIN