Basic Information
| Provider Information | |||||||||
| NPI: | 1295963213 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARMS | ||||||||
| FirstName: | LEA | ||||||||
| MiddleName: | KATRIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 EOFF ST | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260033823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042348663 | ||||||||
| FaxNumber: | 3042348960 | ||||||||
| Practice Location | |||||||||
| Address1: | 2115 CHAPLINE ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260033859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042341610 | ||||||||
| FaxNumber: | 3042341739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2009 | ||||||||
| LastUpdateDate: | 05/26/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301094835 | MI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0000X | 25582 | WV | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
ID Information
| ID | Type | State | Issuer | Description | 3810026839 | 05 | WV | MEDICAID | 0094606 | 05 | OH | MEDICAID |