Basic Information
| Provider Information | |||||||||
| NPI: | 1669517645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEO | ||||||||
| FirstName: | VICKY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 579 | ||||||||
| Address2: | |||||||||
| City: | KITTANNING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162010579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245438164 | ||||||||
| FaxNumber: | 7245438616 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LEECHBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156561333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248451211 | ||||||||
| FaxNumber: | 7248455465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207R00000X | OS008408L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | OS008408L | 01 | PA | PA STATE LICENSE NUMBER | OTHER | 1013011 | 01 | PA | GATEWAY | OTHER | F27496 | 01 | PA | HEALTH AMERICA | OTHER | 70996 | 01 | PA | UNISON | OTHER | 393977 | 01 | PA | MEDICARE | OTHER | 598349 | 01 | PA | BLUE SHIELD | OTHER |