Provider Demographics
NPI:1316117575
Name:KATHARINE LEPPARD, M.D., P.C.
Entity type:Organization
Organization Name:KATHARINE LEPPARD, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-575-1800
Mailing Address - Street 1:3470 CENTENNIAL BLVD
Mailing Address - Street 2:110
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4087
Mailing Address - Country:US
Mailing Address - Phone:719-575-1800
Mailing Address - Fax:719-575-1850
Practice Address - Street 1:3470 CENTENNIAL BLVD
Practice Address - Street 2:110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4087
Practice Address - Country:US
Practice Address - Phone:719-575-1800
Practice Address - Fax:719-575-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35343208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37926870Medicaid
COC811794Medicare UPIN