Healthcare Provider Details

I. General information

NPI: 1396782454
Provider Name (Legal Business Name): LEIGH A GAINES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEIGH ANNIS M.D.

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 VINE ST
CINCINNATI OH
45202-1105
US

IV. Provider business mailing address

3200 VINE ST
CINCINNATI OH
45220-2213
US

V. Phone/Fax

Practice location:
  • Phone: 513-861-3100
  • Fax:
Mailing address:
  • Phone: 513-861-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37401
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35076854
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number37401
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: