MEDICARE: JESSICA THORNER LEUCHTENBURG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	1025066	MA
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	1025066	MA

General Provider Information

NPI Number	:	1851979686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA THORNER LEUCHTENBURG MD

Provider Business Mailing Address
First Line	:	940 BELMONT ST
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-5596
Country	:	US
Telephone Number	:	617-584-0471
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 BELMONT ST
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-5596
Country	:	US
Telephone Number	:	774-826-3819
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	06/01/2026

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