Provider Demographics
NPI:1912525254
Name:CHEPELEV, LEONID LEONIDOVITCH (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONID
Middle Name:LEONIDOVITCH
Last Name:CHEPELEV
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 1:300 PASTEUR DRIVE
Mailing Address - Street 2:S072
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5105
Mailing Address - Country:US
Mailing Address - Phone:650-723-7647
Mailing Address - Fax:
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-245-3613
Practice Address - Fax:513-585-5511
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1685862085R0202X
OH35.1431042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0455334Medicaid
CAA168586OtherMEDICAL BOARD OF CALIFORNIA LICENSE