Most Relevant Information
Provider Data
| NPI Number: | 1003340175 |
| Provider Name: | ALIDA OVRUTSKY LEAVITT M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: | TL.0006651 |
Most Important Dates
| Enumeration Date: | 04/16/2017 |
| Last Updated: | 04/04/2022 |
Provider Practice Location
84 MARGINAL WAY STE 900
PORTLAND
ME
041012476
Practice Location Phone/Fax
| Phone: | 2078742445 |
| Fax: | 2075238598 |
Provider Mailing Location
100 GANNETT DR STE C
SOUTH PORTLAND
ME
041065900
Provider Mailing Phone/Fax
| Phone: | 2078280361 |
| Fax: | 2078741483 |