Provider Demographics
NPI:1922063577
Name:RONEN, LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:RONEN
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 1:97 GREAT TEAYS BLVD
Mailing Address - Street 2:STE 6
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9815
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-757-3252
Practice Address - Street 1:97 GREAT TEAYS BLVD
Practice Address - Street 2:STE 6
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-9815
Practice Address - Country:US
Practice Address - Phone:304-757-6999
Practice Address - Fax:304-757-3252
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19878207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110190764OtherRAILROAD MEDICARE
WV0054842-000Medicaid
WVWV5966AMedicare PIN
RO0886406Medicare PIN
RO0886403Medicare PIN
WV0054842-000Medicaid
110190764Medicare PIN
G41737Medicare UPIN
WVWV5966BMedicare PIN
WVWV5966CMedicare PIN
RO0886405Medicare PIN
WVWV5966DMedicare PIN