Healthcare Provider Details

I. General information

NPI: 1821211723
Provider Name (Legal Business Name): KATHLEEN M LEAVITT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BORTHWICK AVE MEDICAL OFFICE BUILDING
PORTSMOUTH NH
03801-7128
US

IV. Provider business mailing address

PO BOX 231
NEW CASTLE NH
03854-0231
US

V. Phone/Fax

Practice location:
  • Phone: 603-431-5858
  • Fax: 603-431-5818
Mailing address:
  • Phone: 603-431-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0174 P
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: