Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | DO00496 | RI |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO00496 | RI |
Y | 207Q00000X | Family Doctor | DO00496 | RI |
NPI | 1801893367 |
---|---|
Provider Name | Dr. Polly E Leonard |
First Address | Warwick, RI 02886 |
Second Address | Warwick, RI 02886 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 17/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0100985 | UNITED HEALTH (01) | RI |
1972746550 | NPI (01) | |
27623 | BLUE CROSS BLUE SHIELD (01) | RI |
405246 | BLUE CHIP (01) | RI |
710678 | HARVARD PILGRIM (01) | RI |
9002762 | (05) | RI |
G93692 | (02) |