Provider Demographics
NPI:1043286651
Name:LEDDY, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LEDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 FARBER HALL
Mailing Address - Street 2:3435 MINS STREET
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-8001
Mailing Address - Country:US
Mailing Address - Phone:716-829-3670
Mailing Address - Fax:
Practice Address - Street 1:160 FARBER HALL
Practice Address - Street 2:3435 MINS STREET
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-8001
Practice Address - Country:US
Practice Address - Phone:716-829-3670
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174724207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01132250Medicaid
NY14248DMedicare ID - Type Unspecified