Provider Demographics
NPI:1124060637
Name:LEDER INTERNAL MEDICINE ASSOCIATES PC
Entity type:Organization
Organization Name:LEDER INTERNAL MEDICINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-759-2985
Mailing Address - Street 1:3464 S WILLOW ST
Mailing Address - Street 2:SUITE 166
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4531
Mailing Address - Country:US
Mailing Address - Phone:303-755-2900
Mailing Address - Fax:303-755-0404
Practice Address - Street 1:1325 S COLORADO BLVD
Practice Address - Street 2:SUITE B306
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3303
Practice Address - Country:US
Practice Address - Phone:303-759-2985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04112041Medicaid
COLE11204OtherBLUE SHIELD
COCS2534OtherRAILROAD MEDICARE
COCS2534OtherRAILROAD MEDICARE