Individual
KINNARD J LEATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
545 N RIVER ST, #130, WILKES BARRE, PA 18702-2600
(570) 552-2760
(570) 552-2765
Mailing address
545 N RIVER ST, #130, WILKES BARRE, PA 18702-2600
(570) 552-2760
(570) 552-2765
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MA079207
NJ
208600000X
Surgery Physician
Primary
MD418397
PA
2086S0102X
Surgical Critical Care Physician
MA076933
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018088940006
—
PA
05
—
0039381
—
NJ
01
—
1087117
AETNA
NJ
01
—
2404983000
AMERIHEALTH
NJ
01
—
P3624813
OXFORD
NJ
Enumeration date
05/25/2006
Last updated
12/05/2016
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