Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD24923 | ME |
NPI | 1003340175 |
---|---|
Provider Name | Dr. Alida Ovrutsky Leavitt |
First Address | South Portland, ME 04106-5900 |
Second Address | Portland, ME 04101-2476 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2017 |
Last Update Date | 02/09/2021 |