Provider Demographics
NPI:1356429534
Name:LEACH, TIMOTHY A (MD FACOG)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:LEACH
Suffix:
Gender:
Credentials:MD FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 TAMPICO STE 210
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2962
Mailing Address - Country:US
Mailing Address - Phone:925-935-6952
Mailing Address - Fax:925-935-1396
Practice Address - Street 1:110 TAMPICO STE 210
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2962
Practice Address - Country:US
Practice Address - Phone:925-935-6952
Practice Address - Fax:925-935-1396
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81727207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H38774Medicare UPIN
CA00G817270Medicare PIN