Provider Demographics
NPI:1801893607
Name:LEICHTER, CARL M (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:M
Last Name:LEICHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38375 N 102ND ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-3012
Mailing Address - Country:US
Mailing Address - Phone:516-967-1132
Mailing Address - Fax:516-766-4690
Practice Address - Street 1:38375 N 102ND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-3012
Practice Address - Country:US
Practice Address - Phone:516-967-1132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126210-1207N00000X
AZ308999207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY340481Medicare ID - Type Unspecified
NYB13401Medicare UPIN