Provider Demographics
NPI:1134134950
Name:LEITH, PHOEBE J (MD)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:J
Last Name:LEITH
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 1:34 UNION ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2727
Mailing Address - Country:US
Mailing Address - Phone:203-453-8894
Mailing Address - Fax:
Practice Address - Street 1:34 UNION ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2727
Practice Address - Country:US
Practice Address - Phone:203-453-8894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035386207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001353862Medicaid
CT050001414Medicare ID - Type Unspecified
CT001353862Medicaid