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NPI Code Detail

MEDICARE: BRUCE E LEITER M.D.

MEDICARE: BRUCE E LEITER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207U00000XNuclear Medicine Physician012519ME
22085R0202XDiagnostic Radiology Physician012519ME
3208600000XSurgery Physician012519ME

General Provider Information

NPI Number : 1306840806
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE E LEITER M.D.
Provider Business Mailing Address
First Line : PO BOX 1849
Second Line :
City : LEWISTON
State : ME
Zip : 04241-1849
Country : US
Telephone Number : 207-784-2554
Fax Number : 207-783-4079
Provider Business Practice Location Address
First Line : 6 GLEN COVE DR
Second Line :
City : ROCKPORT
State : ME
Zip : 04856-4240
Country : US
Telephone Number : 207-596-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 07/16/2007

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Directions to “ BRUCE E LEITER M.D.” Practice Location

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