Healthcare Provider Details

I. General information

NPI: 1386176980
Provider Name (Legal Business Name): WILLIAM LEAVITT III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TRIPP LEAVITT MD

II. Dates (important events)

Enumeration Date: 04/01/2017
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 OAK ST
PITTSTON PA
18640-3798
US

IV. Provider business mailing address

1201 OAK ST
PITTSTON PA
18640-3798
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-1093
  • Fax: 570-808-9848
Mailing address:
  • Phone: 570-808-1093
  • Fax: 570-808-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberMD486187
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: