Provider Demographics
NPI:1821178211
Name:AVRUCH, LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:AVRUCH
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 1:118 GRANDIEW RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:ON
Mailing Address - Zip Code:K2H 8B2
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 GRANDIEW RD
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:ON
Practice Address - Zip Code:K2H 8B2
Practice Address - Country:CA
Practice Address - Phone:613-829-9525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045931L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology