Basic Information
| Provider Information | |||||||||
| NPI: | 1245415140 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEYTON-MANGE | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | STEWART | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 96 CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | SCARBOROUGH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040747163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078859905 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 96 CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | SCARBOROUGH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040747163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078859905 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2008 | ||||||||
| LastUpdateDate: | 05/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD21957 | ME | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | MD21957 | ME | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
No ID Information.