Provider Demographics
NPI:1508803586
Name:LEITNER, MARC JAY (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:JAY
Last Name:LEITNER
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 1:657 TOWN CENTER DR
Mailing Address - Street 2:NICU
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144
Mailing Address - Country:US
Mailing Address - Phone:702-233-7786
Mailing Address - Fax:702-233-7423
Practice Address - Street 1:657 TOWN CENTER DR
Practice Address - Street 2:NICU
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144
Practice Address - Country:US
Practice Address - Phone:702-233-7786
Practice Address - Fax:702-233-7423
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10453174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVA90986Medicare UPIN