Provider Demographics
NPI:1649568379
Name:LEICHLITER, TIMOTHY A (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:LEICHLITER
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 1:490 E NORTH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4765
Mailing Address - Country:US
Mailing Address - Phone:412-359-8860
Mailing Address - Fax:412-359-8809
Practice Address - Street 1:490 E NORTH AVE STE 500
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4765
Practice Address - Country:US
Practice Address - Phone:412-359-8860
Practice Address - Fax:412-359-8809
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4480762084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102825032Medicaid
12547308OtherCAQH