Healthcare Provider Details

I. General information

NPI: 1598859480
Provider Name (Legal Business Name): JOHN LEWIS LEAHY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST 5TH FLOOR - ENDOCRINE
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

248 RIDGEFIELD RD
SHELBURNE VT
05482-6309
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4576
  • Fax:
Mailing address:
  • Phone: 802-985-2077
  • Fax: 802-656-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number42000-9309
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: