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NPI Code Detail

MEDICARE: DR. KERRY LECKY M.D.

MEDICARE: DR. KERRY LECKY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician35.122117OH
2208M00000XHospitalist Physician1464166MD
3208M00000XHospitalist Physician35.122117OH
4208M00000XHospitalist Physician0979243VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396952651
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KERRY LECKY M.D.
Provider Business Mailing Address
First Line : PO BOX 449
Second Line :
City : MARIETTA
State : OH
Zip : 45750-0449
Country : US
Telephone Number : 740-374-1413
Fax Number :
Provider Business Practice Location Address
First Line : 3535 SOUTHERN BLVD
Second Line :
City : KETTERING
State : OH
Zip : 45429-1221
Country : US
Telephone Number : 937-395-6665
Fax Number : 937-395-6668
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2007
Last Update Date : 01/12/2026

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Directions to “ DR. KERRY LECKY M.D.” Practice Location

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