Provider Demographics
NPI:1801893367
Name:LEONARD, POLLY E (DO)
Entity type:Individual
Prefix:DR
First Name:POLLY
Middle Name:E
Last Name:LEONARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:390 TOLL GATE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4326
Mailing Address - Country:US
Mailing Address - Phone:401-732-2031
Mailing Address - Fax:888-948-3254
Practice Address - Street 1:390 TOLLGATE ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-732-2031
Practice Address - Fax:888-948-3254
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00496204D00000X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972746550OtherNPI
RI27623OtherBLUE CROSS BLUE SHIELD
RI405246OtherBLUE CHIP
RI9002762Medicaid
RI0100985OtherUNITED HEALTH
RI710678OtherHARVARD PILGRIM
089002762Medicare ID - Type Unspecified
RI27623OtherBLUE CROSS BLUE SHIELD