Provider Demographics
NPI:1407852155
Name:LEACH, RICHARD T (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:LEACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1050 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3655
Mailing Address - Country:US
Mailing Address - Phone:401-467-6257
Mailing Address - Fax:401-785-1191
Practice Address - Street 1:5555 POST RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3412
Practice Address - Country:US
Practice Address - Phone:401-884-2229
Practice Address - Fax:401-884-0850
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003058Medicaid
E02907Medicare UPIN