Provider Demographics
NPI:1124014048
Name:LEDDY, FRANKLIN FRASER (MD)
Entity Type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:FRASER
Last Name:LEDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2922
Mailing Address - Country:US
Mailing Address - Phone:401-596-0964
Mailing Address - Fax:401-596-8634
Practice Address - Street 1:35 WELLS ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2922
Practice Address - Country:US
Practice Address - Phone:401-596-0964
Practice Address - Fax:401-596-8634
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT29809208800000X
RI7511208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000205Medicaid
RI0000205Medicaid
E02440Medicare UPIN
RI349023512Medicare PIN