Provider Demographics
NPI:1205810918
Name:LEABERRY, MARSHA SLAUGHTER (MD)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:SLAUGHTER
Last Name:LEABERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:SLAUGHTER
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:RADIOLOGY INC
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25712-0910
Mailing Address - Country:US
Mailing Address - Phone:304-522-1550
Mailing Address - Fax:304-522-1073
Practice Address - Street 1:3448 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2906
Practice Address - Country:US
Practice Address - Phone:304-522-1550
Practice Address - Fax:304-522-0704
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1627652085R0202X
KY371422085R0202X
OH35.0807332085R0202X
WV176372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0955677Medicaid
WV55049337600OtherWORKMANS COMP
000757604OtherMTN STATE BCBS
4458634OtherAETNA
OH000000194480OtherUNISON
WV300042676OtherRR MEDICARE (WV)
KY6470009900Medicaid
WV0119925000Medicaid
KY50007252OtherPASSPORT
WV55049337600OtherWORKMANS COMP
KY0683107Medicare PIN
000757604OtherMTN STATE BCBS
OH0955677Medicaid