Provider Demographics
NPI:1992045165
Name:LEEDHAM, KRISTINA E (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:E
Last Name:LEEDHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 WASHINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6022
Mailing Address - Country:US
Mailing Address - Phone:781-762-0471
Mailing Address - Fax:781-762-8072
Practice Address - Street 1:51 OBERY ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2129
Practice Address - Country:US
Practice Address - Phone:508-732-6770
Practice Address - Fax:508-732-6780
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAPA4563363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant