Basic Information
| Provider Information | |||||||||
| NPI: | 1790706281 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEITNER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | WELKER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 243 W SHORE RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH HERO | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054864615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023726203 | ||||||||
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| Practice Location | |||||||||
| Address1: | 354 MOUNTAIN VIEW DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | COLCHESTER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054465968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028473340 | ||||||||
| FaxNumber: | 8028477083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 2082S0105X | VT | Y | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand |
ID Information
| ID | Type | State | Issuer | Description | 0006165 | 05 | VT | MEDICAID | E00860980 | 05 | NY | MEDICAID |