Provider Demographics
NPI:1124512751
Name:ROTERT, LEANNYN MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:LEANNYN
Middle Name:MARIE
Last Name:ROTERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636256
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-6200
Mailing Address - Fax:513-245-3672
Practice Address - Street 1:200 ALBERT SABIN WAY INFECTIOUS DISEASE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-2364
Practice Address - Country:US
Practice Address - Phone:513-584-6977
Practice Address - Fax:513-584-0359
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
OH58.031892390200000X
OH34.016486207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program