Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 35032575L | OH |
NPI | 1003893124 |
---|---|
Provider Name | Dr. Marvin E Leedy |
First Address | Barberton, OH 44203-4281 |
Second Address | Barberton, OH 44203-4281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 13/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000131917 | ANTHEM (01) | OH |
0455010 | (05) | OH |
0800638 | UNITED HEALTHCARE (01) | OH |
0800639 | CIGNA (01) | OH |
0800722 | UNITED FOOD COMMERCIAL (01) | OH |
0800723 | AETNA (01) | OH |
1058 | HOMETOWN (01) | OH |
A79928 | (02) | OH |