MEDICARE: JENNIFER L LEAVITT D.O.

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
1	207R00000X	Internal Medicine Physician	1709	WV

Other Identifiers

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

General Provider Information

NPI Number	:	1699778472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L LEAVITT D.O.

Provider Business Mailing Address
First Line	:	936 MARKET ST
Second Line	:
City	:	PARKERSBURG
State	:	WV
Zip	:	26101-4737
Country	:	US
Telephone Number	:	304-485-0272
Fax Number	:	304-485-0265

Provider Business Practice Location Address
First Line	:	2900 EMERSON AVE
Second Line	:
City	:	PARKERSBURG
State	:	WV
Zip	:	26104-2519
Country	:	US
Telephone Number	:	304-485-0272
Fax Number	:	304-485-0265

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	09/08/2022

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