Provider Demographics
NPI:1770584690
Name:LEAHEY, EDWARD WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WILLIAM
Last Name:LEAHEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 GARTH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3154
Mailing Address - Country:US
Mailing Address - Phone:281-422-3113
Mailing Address - Fax:281-427-6289
Practice Address - Street 1:4201 GARTH RD
Practice Address - Street 2:100
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3167
Practice Address - Country:US
Practice Address - Phone:281-422-3113
Practice Address - Fax:281-427-6289
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9763207RI0011X, 207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2832697OtherCIGNA
TX009337OtherMEDICARE GROU
TX0095PVOtherBC/BS
TX10014586OtherAMERIGROUP
TX9567607OtherGHI
TXDF1985OtherMEDICARE RR
TX00542OtherAETNA PPO
TX133830308Medicaid
TX180530102Medicaid
TX4080535OtherAETNA HMO
TX8AG820OtherBC/BS