Healthcare Provider Details

I. General information

NPI: 1205070869
Provider Name (Legal Business Name): CANDACE L LEIGH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 07/03/2021
Certification Date: 07/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-2432
US

IV. Provider business mailing address

1411 AURORA HUDSON RD
AURORA OH
44202-8408
US

V. Phone/Fax

Practice location:
  • Phone: 216-399-9809
  • Fax:
Mailing address:
  • Phone: 330-414-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.099169
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number35.099169
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: