Provider Demographics
NPI:1669421129
Name:EIDEN, LEAH CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:CHRISTINE
Last Name:EIDEN
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 1:1740 N PERRY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-1173
Mailing Address - Country:US
Mailing Address - Phone:419-523-0012
Mailing Address - Fax:419-523-3416
Practice Address - Street 1:204 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-1284
Practice Address - Country:US
Practice Address - Phone:419-996-5002
Practice Address - Fax:419-996-5001
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075407207Q00000X
OH35.075407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH04639OtherPARAMOUNT
OHP00187965OtherRAILROAD CARE
OH000000344045OtherANTHEM BC/BS
OH735435OtherBUCKEYE
OHP00472599OtherRAILROAD CARE
OH2176934Medicaid
OH000000550108OtherANTHEM BC/BS
OH000000344045OtherANTHEM BC/BS
OH735435OtherBUCKEYE
OH000000550108OtherANTHEM BC/BS