Basic Information
| Provider Information | |||||||||
| NPI: | 1780680934 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEIBY | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 810 JASONWAY AVE | ||||||||
| Address2: | STE A | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432144359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144423130 | ||||||||
| FaxNumber: | 6144423145 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 JASONWAY AVE | ||||||||
| Address2: | STE A | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432144359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144423130 | ||||||||
| FaxNumber: | 6144423145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 35046908 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0554163 | 05 | OH | MEDICAID | 1435 | 01 | OH | NATIONWIDE | OTHER | 00000014181 | 01 | OH | ANTHEM | OTHER | 3600076 | 01 | OH | UHC | OTHER |