Provider Demographics
NPI:1255522611
Name:LEADER, MERVIN NIGEL (MD)
Entity type:Individual
Prefix:DR
First Name:MERVIN
Middle Name:NIGEL
Last Name:LEADER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:303 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-1203
Mailing Address - Country:US
Mailing Address - Phone:618-842-4617
Mailing Address - Fax:618-847-8387
Practice Address - Street 1:844 COUNTY ROAD 2150 E
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-2823
Practice Address - Country:US
Practice Address - Phone:479-259-8855
Practice Address - Fax:870-364-9774
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-55152084P0800X
IL0361635622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5H025Medicare PIN