Healthcare Provider Details

I. General information

NPI: 1003338278
Provider Name (Legal Business Name): LEAH KIDDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PARK AVE
COHOCTON NY
14826-9401
US

IV. Provider business mailing address

10869 STATE ROUTE 36
DANSVILLE NY
14437-9444
US

V. Phone/Fax

Practice location:
  • Phone: 585-384-5310
  • Fax:
Mailing address:
  • Phone: 585-335-3100
  • Fax: 585-335-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number020888
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number020888
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number020888
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: