Provider Demographics
NPI:1902666597
Name:CARLONI, LEAH GRETCHEN
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:GRETCHEN
Last Name:CARLONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 E RICH ST APT 1215
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5375
Mailing Address - Country:US
Mailing Address - Phone:614-551-1787
Mailing Address - Fax:
Practice Address - Street 1:80 E RICH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5249
Practice Address - Country:US
Practice Address - Phone:614-551-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008702RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty