Provider Demographics
NPI:1700878717
Name:JONES, LEAH JEANNETTE (DO)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:JEANNETTE
Last Name:JONES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MEDICAL PARK
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6390
Mailing Address - Country:US
Mailing Address - Phone:304-243-7030
Mailing Address - Fax:304-243-4282
Practice Address - Street 1:20 MEDICAL PARK
Practice Address - Street 2:SUITE 306
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6390
Practice Address - Country:US
Practice Address - Phone:304-243-7030
Practice Address - Fax:304-243-4282
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV55035705708OtherWV COMPENSATION
OH2288199Medicaid
001718173OtherMOUNTAIN STATE BCBS
1859OtherHEALTH PLAN OF UPPER OH V
WV2000310000Medicaid
WV7291431Medicare ID - Type Unspecified
OH2288199Medicaid
P00161251Medicare ID - Type UnspecifiedRAILROAD MEDICARE