MEDICARE: KATHRYN LEOPOLD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	207916-3	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	040426007730	OTHER	NY	FIDELIS
2	557E61	OTHER	NY	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	10022036	OTHER	NY	CDPHP
5	000405203007	OTHER	NY	BLUE SHIELD
6	391213	OTHER	NY	MVP

General Provider Information

NPI Number	:	1912901588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN LEOPOLD

Provider Business Mailing Address
First Line	:	1775 WILLISTON RD STE 110
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-6491
Country	:	US
Telephone Number	:	802-735-1252
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 WILLISTON RD STE 110
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-6491
Country	:	US
Telephone Number	:	802-735-1252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/30/2024

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Directions to “ KATHRYN LEOPOLD ” Practice Location

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