Provider Demographics
NPI:1033918719
Name:TILTON, LEAH MARIE (MSM, PA-C)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:TILTON
Suffix:
Gender:
Credentials:MSM, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 EASTGATE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1591
Mailing Address - Country:US
Mailing Address - Phone:513-981-4202
Mailing Address - Fax:
Practice Address - Street 1:4450 EASTGATE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1591
Practice Address - Country:US
Practice Address - Phone:513-981-4205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.009370RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant