=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205070869
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CANDACE L LEIGH M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2009
-----------------------------------------------------
Last Update Date | 07/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9500 EUCLID AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44195-2432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-399-9809
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1411 AURORA HUDSON RD
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44202-8408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-414-2920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 35.099169
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207PH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Emergency Medicine) Physician
-----------------------------------------------------
License Number | 35.099169
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------