Provider Demographics
NPI:1962416891
Name:LEBOS, HARVEY C (MD)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:C
Last Name:LEBOS
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 1:5400 SUTLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4721
Mailing Address - Country:US
Mailing Address - Phone:912-354-6187
Mailing Address - Fax:912-355-9807
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-354-6187
Practice Address - Fax:912-355-9807
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015953207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA015953OtherMEDICAL LICENSE
SC150605Medicaid
GA000040532GMedicaid
GA000040532AMedicaid
GA000040532EMedicaid
D45914Medicare UPIN
GA90BDBGDMedicare PIN
GA900000828Medicare PIN
GA$$$$$$$$$CMedicare PIN