Basic Information
| Provider Information | |||||||||
| NPI: | 1669421129 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EIDEN | ||||||||
| FirstName: | LEAH | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1740 N PERRY ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | OTTAWA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458751173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195230012 | ||||||||
| FaxNumber: | 4195233416 | ||||||||
| Practice Location | |||||||||
| Address1: | 1740 N PERRY ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | OTTAWA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458751173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195230012 | ||||||||
| FaxNumber: | 4195233416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 05/29/2008 | ||||||||
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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 | 207Q00000X | 35075407 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 735435 | 01 | OH | BUCKEYE | OTHER | P00187965 | 01 | OH | RAILROAD CARE | OTHER | 04639 | 01 | OH | PARAMOUNT | OTHER | 000000550108 | 01 | OH | ANTHEM BC/BS | OTHER | 2176934 | 05 | OH | MEDICAID | 000000344045 | 01 | OH | ANTHEM BC/BS | OTHER | P00472599 | 01 | OH | RAILROAD CARE | OTHER |