Basic Information
| Provider Information | |||||||||
| NPI: | 1134301922 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEIGHTON | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | CHAMAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 OLNEY ST | ||||||||
| Address2: | APT. 2 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029061663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152021872 | ||||||||
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| Practice Location | |||||||||
| Address1: | 65 SOCKANOSSET CROSS RD | ||||||||
| Address2: | |||||||||
| City: | CRANSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029205536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018864830 | ||||||||
| FaxNumber: | 8887797670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2007 | ||||||||
| LastUpdateDate: | 01/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD14401 | RI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | JL94600 | 05 | RI | MEDICAID |