Provider Demographics
NPI:1932288321
Name:LEONARD, DAVID G (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:LEONARD
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 1:3001 HIGHLAND AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2315
Mailing Address - Country:US
Mailing Address - Phone:513-961-8861
Mailing Address - Fax:513-487-3770
Practice Address - Street 1:3001 HIGHLAND AVE STE E
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2315
Practice Address - Country:US
Practice Address - Phone:513-961-8861
Practice Address - Fax:513-487-3770
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350812422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2504776Medicaid
OHLE4315522Medicare PIN
I08561Medicare UPIN
OHLE4135523Medicare PIN
OHLE4135521Medicare PIN