Provider Demographics
NPI:1851317671
Name:LEECH, MARK H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:LEECH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1616 GUNBARREL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4136
Mailing Address - Country:US
Mailing Address - Phone:423-826-8200
Mailing Address - Fax:423-826-8201
Practice Address - Street 1:1616 GUNBARREL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4136
Practice Address - Country:US
Practice Address - Phone:423-826-8200
Practice Address - Fax:423-826-8201
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000018072208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3154377OtherBLUE
TN4953610OtherCIGNA
TN139412005329OtherHUMANA
TN1340106OtherUHC
TN5959415OtherAETNA
TNA99277Medicare UPIN
TN139412005329OtherHUMANA
TN4953610OtherCIGNA