Provider Demographics
NPI:1316943822
Name:LEITHE, MARK E (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:LEITHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3320 WAKE FOREST RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:919-862-5100
Mailing Address - Fax:919-862-5104
Practice Address - Street 1:3320 WAKE FOREST RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609
Practice Address - Country:US
Practice Address - Phone:919-862-5100
Practice Address - Fax:919-862-5104
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC37882207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7951639Medicaid
060035473OtherRAILROAD MEDICARE
060035473OtherRAILROAD MEDICARE
C03276Medicare UPIN
21438820Medicare PIN