Provider Demographics
NPI:1225213481
Name:J LEITAO-PINA MD PC
Entity Type:Organization
Organization Name:J LEITAO-PINA MD PC
Other - Org Name:ADULT HEALTHCARE & WELNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEITAO-PINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-853-8700
Mailing Address - Street 1:299 LINCOLN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3646
Mailing Address - Country:US
Mailing Address - Phone:508-853-8700
Mailing Address - Fax:508-853-8733
Practice Address - Street 1:299 LINCOLN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3646
Practice Address - Country:US
Practice Address - Phone:508-853-8700
Practice Address - Fax:508-853-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care