Andre De Leon (NPI# 1922281633, PAC ID# 0749475648) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1922281633 |
| PAC ID by PECOS | 0749475648 |
| Professional Enrollment ID | I20180703000432 |
| Full Name | Andre De Leon |
| Organization Legal Name | LICKING MEMORIAL PROFESSIONAL CORPORATION |
| Address |
1264 Weaver Dr Granville OH 43023-1257 |
| Phone Number | 2205641940 |
| Gender | M |
| Graduation Year | 2007 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 6204740731 |
| Number of Group Practice Members | 184 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 360218 | LICKING MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 1264 Weaver Dr, Granville, OH 43023-1257 | 2205641940 | LICKING MEMORIAL PROFESSIONAL CORPORATION |
| Organization Legal Name | LICKING MEMORIAL PROFESSIONAL CORPORATION |
| Physicians | 169 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Cynthia Kearse | Obstetrics/gynecology | Licking Memorial Professional Corporation | 15 Messimer Dr, Newark, OH 43055-1841 |
| Michael Isaac Sniderman | Anesthesiology | Licking Memorial Professional Corporation | 1320 W Main St, Newark, OH 43055-1822 |
| Bradley R Lawson | Otolaryngology | Licking Memorial Professional Corporation | 36 Mcmillen Dr, Newark, OH 43055-1809 |
| Donald Fairbanks | Family Medicine | Licking Memorial Professional Corporation | 270 Goosepond Rd, Suite 102, Newark, OH 43055-3104 |
| Troy S Magaw | Physician Assistant | Licking Memorial Professional Corporation | 120 Mcmillen Dr, Newark, OH 43055-1809 |
| Richard D Kennedy | Family Medicine | Licking Memorial Professional Corporation | 96 Integrity Dr, Hebron, OH 43025-7013 |
| Michael D Barth | Family Medicine | Licking Memorial Professional Corporation | 1264 Weaver Dr, Granville, OH 43023-1257 |
| Jacob Z Slepian | Otolaryngology | Licking Memorial Professional Corporation | 88 Mcmillen Dr, Newark, OH 43055-1809 |
| Talya R Greathouse | Family Medicine | Licking Memorial Professional Corporation | 1717 W Main St, Suite 201, Newark, OH 43055-1347 |
| Stephen Pickstone | Psychiatry | Licking Memorial Professional Corporation | 200 Messimer Dr, Newark, OH 43055-3627 |
| Street Address |
1264 WEAVER DR |
| City | GRANVILLE |
| State | OH |
| Zip | 43023-1257 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michael D Barth | Family Medicine | Licking Memorial Professional Corporation | 1264 Weaver Dr, Granville, OH 43023-1257 |
| Kevin T Graham | Family Medicine | Licking Memorial Professional Corporation | 1264 Weaver Dr, Granville, OH 43023-1257 |
| Navin Muni | Family Medicine | Licking Memorial Professional Corporation | 1264 Weaver Dr, Granville, OH 43023-1257 |
| Sarah Dorsky | Nurse Practitioner | Licking Memorial Professional Corporation | 1264 Weaver Dr, Granville, OH 43023-1257 |
| Aaron J Kibler | Family Practice | Licking Memorial Professional Corporation | 1264 Weaver Dr, Granville, OH 43023-1257 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jennifer Lynn Hamilton | Podiatry | 2158 Columbus Rd, Granville, OH 43023-1242 | |
| Dustin C Zimpfer | Chiropractic | 230 Broadway E, Suite 150, Granville, OH 43023-1363 | |
| Kelley Jo Breidigan | Clinical Social Worker | 128 S Main St, Granville, OH 43023-1409 | |
| Karen H Berdan | Optometry | 205 /2 S Prospect St, Granville, OH 43023-1423 | |
| Katherine L Montanaro | Nurse Practitioner | Central Ohio Geriatrics, LLC | 590 Newark Granville Rd, Granville, OH 43023-1436 |
| Tara Dillon | Nurse Practitioner | Central Ohio Geriatrics, LLC | 590 Newark Granville Rd, Granville, OH 43023-1436 |
| Caryn Elizabeth Gorby | Nurse Practitioner | Central Ohio Geriatrics, LLC | 590 Newark Granville Rd, Granville, OH 43023-1436 |
| Jonathan Hollister | Geriatric Medicine | Central Ohio Geriatrics, LLC | 590 Newark Granville Rd, Granville, OH 43023-1436 |
| Chad Douglas Wittekind | Nurse Practitioner | Central Ohio Geriatrics, LLC | 590 Newark Granville Rd, Granville, OH 43023-1436 |
| Stuart Kanter | Family Medicine | Central Ohio Geriatrics, LLC | 590 Newark Granville Rd, Granville, OH 43023-1436 |
| Find all physicians in zip 43023 | |||
| City | GRANVILLE |
| Zip Code | 43023 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | GRANVILLE + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Andre De Leon.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.