Provider Demographics
NPI:1477570018
Name:LEIBOWITZ, DAVID E (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885
Mailing Address - Country:US
Mailing Address - Phone:401-247-1000
Mailing Address - Fax:401-247-1971
Practice Address - Street 1:851 MAIN ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885
Practice Address - Country:US
Practice Address - Phone:401-247-1000
Practice Address - Fax:401-247-1971
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7000765Medicaid
RI7000765Medicaid
RI007004285Medicare PIN