Provider Demographics
NPI:1790987709
Name:ROWAN-KELLY, LEIGH (MD FASAM)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:
Last Name:ROWAN-KELLY
Suffix:
Gender:M
Credentials:MD FASAM
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:CHARLES LEIGH
Other - Last Name:ROWAN-KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD FASAM
Mailing Address - Street 1:100 SUMMIT CREST DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-2944
Mailing Address - Country:US
Mailing Address - Phone:816-416-6168
Mailing Address - Fax:860-430-2672
Practice Address - Street 1:7 ISLAND DOCK RD
Practice Address - Street 2:
Practice Address - City:HADDAM
Practice Address - State:CT
Practice Address - Zip Code:06438-1036
Practice Address - Country:US
Practice Address - Phone:816-416-6168
Practice Address - Fax:860-430-2672
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT68097207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR390200000XOtherTAXONOMY