Healthcare Provider Details

I. General information

NPI: 1720050073
Provider Name (Legal Business Name): MICHAEL T. LEAHY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109B COUNTY RD
NORTH FALMOUTH MA
02556-2019
US

IV. Provider business mailing address

109 B COUNTY ROAD
NORTH FALMOUTH MA
02556
US

V. Phone/Fax

Practice location:
  • Phone: 508-563-6655
  • Fax: 508-563-5119
Mailing address:
  • Phone: 508-563-6655
  • Fax: 508-563-5119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number48990
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: