Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 0101231519 | VA |
Y | 213ES0000X | Sports Medicine | 0101231519 | VA |
NPI | 1366534349 |
---|---|
Provider Name | Matthew N Leyton |
First Address | Virginia Beach, VA 23471-0371 |
Second Address | Virginia Beach, VA 23455-6010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 01/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H43021 | (02) |