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General NPI Number Information
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NPI Number | 1265653596
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Entity Type | Individual
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Provider Name | EDWIN LOCKWOOD LEAVITT PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2257 HUBER ROAD
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City | FORT MEADE
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State | MD
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Zip | 20755-5378
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Country | US
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Telephone | 443-845-6295
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Fax | 301-677-7149
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Provider Business Mailing Address
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Address Line | 2043 RIVER DOWNS CT
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City | FOREST HILL
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State | MD
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Zip | 21050-3142
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Country | US
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Telephone | 443-845-6295
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Fax | 301-677-7149
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0001832
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License Number State | MD
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