MEDICARE: DR. LEIGH ROWAN-KELLY MD FASAM

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	207QA0401X	Addiction Medicine (Family Medicine) Physician	68097	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	390200000X	OTHER	OR	TAXONOMY

General Provider Information

NPI Number	:	1790987709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEIGH ROWAN-KELLY MD FASAM

Provider Business Mailing Address
First Line	:	100 SUMMIT CREST DR
Second Line	:
City	:	SOUTH GLASTONBURY
State	:	CT
Zip	:	06073-2944
Country	:	US
Telephone Number	:	816-416-6168
Fax Number	:	860-430-2672

Provider Business Practice Location Address
First Line	:	7 ISLAND DOCK RD
Second Line	:
City	:	HADDAM
State	:	CT
Zip	:	06438-1036
Country	:	US
Telephone Number	:	816-416-6168
Fax Number	:	860-430-2672

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

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	12/27/2024

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