MEDICARE: SHERRY 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	2084N0400X	Neurology Physician	202583-1	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	:	1659341956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY WITHIAM LEITCH MD

Provider Business Mailing Address
First Line	:	415 TREMONT ST
Second Line	:
City	:	N TONAWANDA
State	:	NY
Zip	:	14120-6135
Country	:	US
Telephone Number	:	716-689-1901
Fax Number	:	716-689-2238

Provider Business Practice Location Address
First Line	:	415 TREMONT ST
Second Line	:
City	:	N TONAWANDA
State	:	NY
Zip	:	14120-6135
Country	:	US
Telephone Number	:	716-689-1901
Fax Number	:	716-689-2238

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/08/2007

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