Provider Demographics
NPI:1447525035
Name:JUDGE, LEIGH A (PA-C)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:A
Last Name:JUDGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CHELTENHAM DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1718
Mailing Address - Country:US
Mailing Address - Phone:937-432-0348
Mailing Address - Fax:
Practice Address - Street 1:3716 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4845
Practice Address - Country:US
Practice Address - Phone:937-298-1439
Practice Address - Fax:937-298-7422
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003384RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0121989Medicaid