Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD434613 | MD |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD434613 | PA |
NPI | 1083753339 |
---|---|
Provider Name | Kevin Patrick Leahy |
First Address | Philadelphia, PA 19107-6130 |
Second Address | Philadelphia, PA 19107-6130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 28/03/2012 |