Basic Information
| Provider Information | |||||||||
| NPI: | 1073532339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEONE | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 263 FARMINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060300001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606794477 | ||||||||
| FaxNumber: | 8606794474 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 WEST ST | ||||||||
| Address2: | |||||||||
| City: | SOUTHINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064896025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602766000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 07/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 035801 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2286124 | 01 | CT | AETNA | OTHER | 00135801002 | 01 | CT | BLUE CARE FAMILY PLAN | OTHER | 035801 | 01 | CT | CONNECTICARE | OTHER | 010035801CT03 | 01 | CT | ANTHEM BC/BS | OTHER | 061571622 | 01 | CT | UNITED HEALTHCARE | OTHER | 061571622 | 01 | CT | CIGNA | OTHER | P490553 | 01 | CT | OXFORD | OTHER | 001358010 | 05 | CT | MEDICAID | 110201458 | 01 | CT | RAILROAD MEDICARE | OTHER | OV6502 | 01 | CT | HEALTHNET | OTHER |