Provider Demographics
NPI:1316029226
Name:LEAVITT, MATTHEW A (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:LEAVITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28 WHITE BRIDGE RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1499
Mailing Address - Country:US
Mailing Address - Phone:615-356-4111
Mailing Address - Fax:615-356-8011
Practice Address - Street 1:28 WHITE BRIDGE RD
Practice Address - Street 2:STE. 300
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1499
Practice Address - Country:US
Practice Address - Phone:615-356-4111
Practice Address - Fax:615-356-8011
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN53342207RN0300X
MI4301081869207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH72602Medicare UPIN
MIH72602Medicare UPIN