Healthcare Provider Details

I. General information

NPI: 1588699748
Provider Name (Legal Business Name): LEAH K CLOUGH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 DURHAM RD STE 105
DOVER NH
03820-4380
US

IV. Provider business mailing address

7 WORKS WAY
SOMERSWORTH NH
03878-1639
US

V. Phone/Fax

Practice location:
  • Phone: 603-537-1300
  • Fax:
Mailing address:
  • Phone: 603-692-4018
  • Fax: 833-944-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0492
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: