Provider Demographics
NPI:1780678078
Name:LEOPOLD, KENNETH ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALBERT
Last Name:LEOPOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MOUNTAIN ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2105
Mailing Address - Country:US
Mailing Address - Phone:860-679-9392
Mailing Address - Fax:
Practice Address - Street 1:80 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102-8000
Practice Address - Country:US
Practice Address - Phone:860-545-2803
Practice Address - Fax:860-545-1500
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0375432085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001375436Medicaid
E01432Medicare UPIN
920000028Medicare ID - Type Unspecified