Provider Demographics
NPI:1811076276
Name:LEITER, ELLIOT (MD)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:
Last Name:LEITER
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 1:10454 ARROW POINT DRIVE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110
Mailing Address - Country:US
Mailing Address - Phone:206-780-0661
Mailing Address - Fax:206-780-0661
Practice Address - Street 1:10454 ARROW POINT DRIVE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110
Practice Address - Country:US
Practice Address - Phone:206-780-0661
Practice Address - Fax:206-780-0661
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029163208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology