Basic Information
| Provider Information | |||||||||
| NPI: | 1912901588 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEOPOLD | ||||||||
| FirstName: | KATHRYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 HUDSON AVE | ||||||||
| Address2: | PO BOX 144 | ||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128014313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187934477 | ||||||||
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| Practice Location | |||||||||
| Address1: | 45 HUDSON AVE | ||||||||
| Address2: | |||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128014313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187934477 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2005 | ||||||||
| 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 | 207V00000X | 207916-3 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 01766343 | 05 | NY | MEDICAID | 000405203007 | 01 | NY | BLUE SHIELD | OTHER | 557E61 | 01 | NY | BLUE CROSS | OTHER | 040426007730 | 01 | NY | FIDELIS | OTHER | 391213 | 01 | NY | MVP | OTHER | 10022036 | 01 | NY | CDPHP | OTHER |