Healthcare Provider Details

I. General information

NPI: 1417393273
Provider Name (Legal Business Name): LYVIA Y. LEIGH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 KINGS HWY STE 102
LEWES DE
19958-1772
US

IV. Provider business mailing address

750 KINGS HWY STE 102
LEWES DE
19958-1772
US

V. Phone/Fax

Practice location:
  • Phone: 302-643-4123
  • Fax: 888-979-9165
Mailing address:
  • Phone: 302-643-4123
  • Fax: 888-979-9165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD465089
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberMD465089
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberC1-0024361
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: