Provider Demographics
NPI:1821211723
Name:LEAVITT, KATHLEEN M (PA)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:NH
Mailing Address - Zip Code:03854-0231
Mailing Address - Country:US
Mailing Address - Phone:603-431-5858
Mailing Address - Fax:
Practice Address - Street 1:333 BORTHWICK AVE
Practice Address - Street 2:MEDICAL OFFICE BUILDING
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-431-5858
Practice Address - Fax:603-431-5818
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0174 P363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MELEAP1114Medicare ID - Type UnspecifiedMAINE MEDICARE
NHS32237Medicare UPIN
NHLEAPO208Medicare ID - Type UnspecifiedNH MEDICARE