Provider Demographics
NPI:1700064995
Name:LEVERAGE, SCOTT CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CHARLES
Last Name:LEVERAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 CENTRE VIEW BLVD
Mailing Address - Street 2:GASTROENTEROLOGY
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3409
Mailing Address - Country:US
Mailing Address - Phone:859-341-3575
Mailing Address - Fax:859-341-5701
Practice Address - Street 1:425 CENTRE VIEW BLVD
Practice Address - Street 2:GASTROENTEROLOGY
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3409
Practice Address - Country:US
Practice Address - Phone:859-341-3575
Practice Address - Fax:859-341-5701
Is Sole Proprietor?:No
Enumeration Date:2008-02-10
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41822207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201077440Medicaid
KY7100067320Medicaid
OH0064749Medicaid
IN201077440Medicaid