Provider Demographics
NPI:1972692036
Name:LEACH, JOHN ALBERT (PA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALBERT
Last Name:LEACH
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Gender:M
Credentials:PA
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Mailing Address - Street 1:WEST HAVEN VETERAN'S HOSPITAL
Mailing Address - Street 2:950 CAMPBELL AVE.
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2700
Mailing Address - Country:US
Mailing Address - Phone:203-932-5711
Mailing Address - Fax:203-867-7600
Practice Address - Street 1:WEST HAVEN VETERAN'S HOSPITAL
Practice Address - Street 2:950 CAMPBELL AVENUE
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2700
Practice Address - Country:US
Practice Address - Phone:203-932-5711
Practice Address - Fax:203-867-7600
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CT000327363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant