Provider Demographics
NPI:1841678109
Name:OTWORTH, LEONARD HERBERT IV (DO)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:HERBERT
Last Name:OTWORTH
Suffix:IV
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:2001 SCIOTO TRL STE 300
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2845
Practice Address - Country:US
Practice Address - Phone:740-353-6390
Practice Address - Fax:740-353-6290
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2018-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34.012427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine