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General NPI Number Information
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NPI Number | 1720519226
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Entity Type | Individual
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Provider Name | ADAM ROSS LEAVITT M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2017
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 2915 LAKEVIEW DR STE 32730
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City | FERN PARK
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State | FL
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Zip | 32730-2050
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Country | US
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Telephone | 407-834-9091
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Fax |
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Provider Business Mailing Address
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Address Line | 120 INTERNATIONAL PKWY STE 240
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City | HEATHROW
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State | FL
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Zip | 32746-5033
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Country | US
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Telephone | 407-675-6733
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME150502
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | ME150502
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License Number State | FL
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