Provider Demographics
NPI:1124158225
Name:ROMER, LEIGH ANN (PA-C)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:ROMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:ANN
Other - Last Name:WEINFURTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:9 RICHLAND MEDICAL PARK DR STE 505
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6844
Practice Address - Country:US
Practice Address - Phone:803-434-2505
Practice Address - Fax:803-434-2181
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1001363A00000X
SC2596363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2795PAMedicaid
KY000000631725OtherANTHEM BCBS
KYP00779378OtherRR MEDICARE
KY7100103210Medicaid
KYP00779378OtherRR MEDICARE