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General NPI Number Information
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NPI Number | 1699778472
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Entity Type | Individual
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Provider Name | JENNIFER L LEAVITT D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 2900 EMERSON AVE
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City | PARKERSBURG
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State | WV
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Zip | 26104-2519
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Country | US
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Telephone | 304-485-0272
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Fax | 304-485-0265
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Provider Business Mailing Address
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Address Line | 936 MARKET ST
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City | PARKERSBURG
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State | WV
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Zip | 26101-4737
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Country | US
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Telephone | 304-485-0272
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Fax | 304-485-0265
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 1709
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License Number State | WV
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