MEDICARE: DR. DOMENICO LEUCI MD

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	207V00000X	Obstetrics & Gynecology Physician	232736	NY

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	4127900	OTHER	NY	MVP
3	10087636	OTHER	NY	CDPHP

General Provider Information

NPI Number	:	1851352058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMENICO LEUCI MD

Provider Business Mailing Address
First Line	:	365 HARRY L DR
Second Line	:	STE 110
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1471
Country	:	US
Telephone Number	:	607-754-9870
Fax Number	:	607-785-9862

Provider Business Practice Location Address
First Line	:	365 HARRY L DR STE 110
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1471
Country	:	US
Telephone Number	:	607-729-5805
Fax Number	:	607-729-7714

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	04/09/2024

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Directions to “ DR. DOMENICO LEUCI MD” Practice Location

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