Individual
DR. GARY D LEAVITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5100 W TAFT RD, SUITE 2A, LIVERPOOL, NY 13088-3807
(315) 452-2555
(315) 452-2559
Mailing address
4567 CROSSROADS PARK DR, 2ND FLOOR, LIVERPOOL, NY 13088-3589
(315) 295-2100
(315) 295-2125
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
209921
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00555440
—
NY
05
—
00555500
—
NY
05
—
01813327
—
NY
05
—
02224500
—
NY
Enumeration date
08/17/2005
Last updated
09/13/2007
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