Provider Demographics
NPI:1710645965
Name:LEITAO, SAMANTHA ELIZABETH (MGC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ELIZABETH
Last Name:LEITAO
Suffix:
Gender:F
Credentials:MGC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ELIZABETH
Other - Last Name:DEFERRARI-LEITAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:152 ARLA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-2631
Mailing Address - Country:US
Mailing Address - Phone:443-841-6526
Mailing Address - Fax:412-605-6335
Practice Address - Street 1:4815 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-578-4512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000877207VM0101X
170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170300000XOther Service ProvidersGenetic Counselor, MS
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty