MEDICARE: DR. BLAKE T LEAVITT 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	207P00000X	Emergency Medicine Physician	19814	NH
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	38835	NH

General Provider Information

NPI Number	:	1710349840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAKE T LEAVITT MD

Provider Business Mailing Address
First Line	:	250 PLEASANT ST
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-2598
Country	:	US
Telephone Number	:	603-227-7000
Fax Number	:	603-230-7405

Provider Business Practice Location Address
First Line	:	246 PLEASANT ST STE 206
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-2548
Country	:	US
Telephone Number	:	603-415-6685
Fax Number	:	603-227-7583

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

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	03/16/2026

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