Healthcare Provider Details

I. General information

NPI: 1396898136
Provider Name (Legal Business Name): LEAH MARIE TRIOLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 03/05/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 MEDICAL CENTER ROAD
FORT CAVAZOS TX
76544
US

IV. Provider business mailing address

5005 N PIEDRAS ST WILLIAM BEAUMONT ARMY MEDICAL CENTER
EL PASO TX
79920-5001
US

V. Phone/Fax

Practice location:
  • Phone: 254-288-8190
  • Fax: 254-286-7628
Mailing address:
  • Phone: 915-569-2107
  • Fax: 915-569-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number23858
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number23858
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberD0086905
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberU2752
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: