Provider Demographics
NPI:1861489734
Name:LEIGHTON, RICHARD MATTHEW (DO)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MATTHEW
Last Name:LEIGHTON
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 1:20 MEDICAL CAMPUS DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-4094
Mailing Address - Country:US
Mailing Address - Phone:910-575-5800
Mailing Address - Fax:910-579-1174
Practice Address - Street 1:20 MEDICAL CAMPUS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4094
Practice Address - Country:US
Practice Address - Phone:910-575-5800
Practice Address - Fax:910-579-1174
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600283207X00000X
SC732207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-51630Medicaid
G28982Medicare UPIN
NC2340654Medicare ID - Type Unspecified