MEDICARE: DR. MATTHEW L WITHIAM-LEITCH MD

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	207V00000X	Obstetrics & Gynecology Physician	210331	NY

General Provider Information

NPI Number	:	1568483253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW L WITHIAM-LEITCH MD

Provider Business Mailing Address
First Line	:	219 BRYANT ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14222-2006
Country	:	US
Telephone Number	:	716-878-7263
Fax Number	:	716-888-3833

Provider Business Practice Location Address
First Line	:	445 TREMONT ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6150
Country	:	US
Telephone Number	:	716-690-2406
Fax Number	:	716-690-2638

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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