Provider Demographics
NPI:1588699748
Name:CLOUGH, LEAH K (PA)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:K
Last Name:CLOUGH
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WORKS WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1639
Mailing Address - Country:US
Mailing Address - Phone:603-692-4018
Mailing Address - Fax:833-944-2270
Practice Address - Street 1:15 DURHAM RD STE 105
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4380
Practice Address - Country:US
Practice Address - Phone:603-537-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0492363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077658Medicaid
NH30332813Medicaid
ME405390099Medicaid
NHAP2137Medicare PIN