Basic Information
| Provider Information | |||||||||
| NPI: | 1275520470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DERIGGI | ||||||||
| FirstName: | LEONARD | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3572 BRODHEAD RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MONACA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150613101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247286539 | ||||||||
| FaxNumber: | 7247287416 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 DUTCH RIDGE RD | ||||||||
| Address2: | DEPARTMENT OF RADIOLOGY | ||||||||
| City: | BEAVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150099727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247734567 | ||||||||
| FaxNumber: | 7247289729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 10/14/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD051921L | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0015378800025 | 05 | PA | MEDICAID | 3810006135 | 05 | WV | MEDICAID | 0815059000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | DE789597 | 01 | PA | HIGHMARK | OTHER | 0015378800007 | 05 | PA | MEDICAID |