Provider Demographics
NPI:1851352058
Name:LEUCI, DOMENICO (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMENICO
Middle Name:
Last Name:LEUCI
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 1:365 HARRY L DR
Mailing Address - Street 2:STE 110
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1471
Mailing Address - Country:US
Mailing Address - Phone:607-754-9870
Mailing Address - Fax:607-785-9862
Practice Address - Street 1:365 HARRY L DR STE 110
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1471
Practice Address - Country:US
Practice Address - Phone:607-729-5805
Practice Address - Fax:607-729-7714
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232736207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02630697Medicaid
NY4127900OtherMVP
NY10087636OtherCDPHP
NY02630697Medicaid
NY4127900OtherMVP