MEDICARE: DR. RICHARD LEACH 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
1	207R00000X	Internal Medicine Physician	113207	NY
2	207RI0200X	Infectious Disease Physician	113207	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518951961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD LEACH M.D.

Provider Business Mailing Address
First Line	:	28 SHERMAN AVE
Second Line	:
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-2839
Country	:	US
Telephone Number	:	518-793-6619
Fax Number	:	518-798-3415

Provider Business Practice Location Address
First Line	:	28 SHERMAN AVE
Second Line	:
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-2839
Country	:	US
Telephone Number	:	518-793-6619
Fax Number	:	518-798-3415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	11/01/2007

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