Healthcare Provider Details

I. General information

NPI: 1093210361
Provider Name (Legal Business Name): LEIGHANN MICHELLE DESPOTOVICH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

487 E MOORESTOWN RD STE 105
WIND GAP PA
18091-9683
US

IV. Provider business mailing address

487 E MOORESTOWN RD STE 105
WIND GAP PA
18091-9683
US

V. Phone/Fax

Practice location:
  • Phone: 484-658-5437
  • Fax: 833-514-6946
Mailing address:
  • Phone: 484-526-7740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS022187
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: