Provider Demographics
NPI:1861577587
Name:NIXON, LEILANI L (MD)
Entity type:Individual
Prefix:DR
First Name:LEILANI
Middle Name:L
Last Name:NIXON
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 1:320 POMFRET ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1836
Mailing Address - Country:US
Mailing Address - Phone:860-564-6293
Mailing Address - Fax:860-564-4879
Practice Address - Street 1:31 DOW RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1800
Practice Address - Country:US
Practice Address - Phone:860-564-6293
Practice Address - Fax:860-564-4879
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08368207RG0300X
CT028919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B38733Medicare UPIN
CT110010455Medicare UPIN