Provider Demographics
NPI:1932117959
Name:VAN LEEUWEN, EUGENE JOSEPH (MD)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:JOSEPH
Last Name:VAN LEEUWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 HIGHLAND AVE.
Mailing Address - Street 2:SUITE E
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2315
Mailing Address - Country:US
Mailing Address - Phone:513-961-8861
Mailing Address - Fax:513-487-3770
Practice Address - Street 1:3001 HIGHLAND AVE.
Practice Address - Street 2:SUITE E
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2315
Practice Address - Country:US
Practice Address - Phone:513-961-8861
Practice Address - Fax:513-487-3770
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350558072084P0804X, 2084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1500842OtherEVERCARE
KY6405583300Medicaid
OH000000196583OtherANTHEM
260046462OtherRAILROAD MEDICARE
OH31176049300OtherBWC
198316000OtherMAGELLAN
OH0744387Medicaid
OH0744387Medicaid
OHVA0820042Medicare PIN
OHEUSP00241Medicare PIN
OH000000196583OtherANTHEM