Healthcare Provider Details

I. General information

NPI: 1659336006
Provider Name (Legal Business Name): PATRICK JAMES LEADBITTER PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 ROSTRAVER RD
ROSTRAVER TOWNSHIP PA
15012-1945
US

IV. Provider business mailing address

PO BOX 640631 EMERGENCY MEDICINE OF WASHINGTON HOSPITAL
PITTSBURGH PA
15264-0631
US

V. Phone/Fax

Practice location:
  • Phone: 724-929-3278
  • Fax:
Mailing address:
  • Phone: 610-668-6491
  • Fax: 610-617-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA051846
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: