Provider Demographics
NPI:1972571032
Name:LEAHY, JOANN MARIE (MD)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:MARIE
Last Name:LEAHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4445
Mailing Address - Country:US
Mailing Address - Phone:701-222-6102
Mailing Address - Fax:701-222-6150
Practice Address - Street 1:500 N 8TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4445
Practice Address - Country:US
Practice Address - Phone:701-222-6102
Practice Address - Fax:701-222-6150
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027824E2085R0001X
ND107282085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009113260006Medicaid
C32313Medicare UPIN
PA0009113260006Medicaid