Provider Demographics
NPI:1366534349
Name:LEYTON, MATTHEW N (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:N
Last Name:LEYTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5371
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23471-0371
Mailing Address - Country:US
Mailing Address - Phone:757-363-6900
Mailing Address - Fax:757-363-6654
Practice Address - Street 1:816 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 2C
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6010
Practice Address - Country:US
Practice Address - Phone:757-363-6900
Practice Address - Fax:757-363-6654
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012315192081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H43021Medicare UPIN