Individual
MR. LARRY LEAVITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
369 SOUTH ST, PITTSFIELD, MA 01201-6803
(518) 772-7710
(518) 772-7710
Mailing address
369 SOUTH ST, PITTSFIELD, MA 01201-6803
(518) 772-7710
(518) 772-7710
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
003089
NH
363A00000X
Physician Assistant
0643
NH
363A00000X
Physician Assistant
3089
NY
363AM0700X
Medical Physician Assistant
Primary
2589
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30336040
—
NH
Enumeration date
05/18/2007
Last updated
11/16/2011
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