Provider Demographics
NPI:1851362842
Name:LEACH, JAMES LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LAWRENCE
Last Name:LEACH
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 1:3333 BURNET AVENUE
Mailing Address - Street 2:RADIOLOGY, ML 5031
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4225
Mailing Address - Fax:513-636-2511
Practice Address - Street 1:3333 BURNET AVENUE
Practice Address - Street 2:RADIOLOGY, ML 5031
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4225
Practice Address - Fax:513-636-2511
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 0627422085R0202X
OH35.0627422085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000014178OtherANTHEM
KY64937055Medicaid
OH651677OtherAETNA
OH0991057Medicaid
OH1620973OtherUNITED HEALTHCARE
IN200039070AMedicaid
OHLE0767521Medicare ID - Type Unspecified
OH0991057Medicaid