Provider Demographics
NPI:1891812699
Name:BRETTA, LEIGH ALICE (MD)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:ALICE
Last Name:BRETTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-4670
Mailing Address - Fax:207-973-4661
Practice Address - Street 1:417 STATE ST
Practice Address - Street 2:WEBBER WEST SUITE 141
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6630
Practice Address - Country:US
Practice Address - Phone:207-973-4670
Practice Address - Fax:207-973-4661
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016890207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431955399Medicaid
ME1288920OtherAETNA
ME061496OtherANTHEM OF MAINE
BRME1564Medicare ID - Type Unspecified
ME431955399Medicaid