Provider Demographics
NPI:1922130939
Name:LEITZER, JOAN SCHAAP (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:SCHAAP
Last Name:LEITZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 NEAL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3527
Mailing Address - Country:US
Mailing Address - Phone:207-874-6726
Mailing Address - Fax:207-879-7112
Practice Address - Street 1:18 NEAL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3527
Practice Address - Country:US
Practice Address - Phone:207-874-6726
Practice Address - Fax:207-879-7112
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0139652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM6058Medicare ID - Type Unspecified
ME006500Medicare UPIN