Basic Information
| Provider Information | |||||||||
| NPI: | 1063490167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEONARD | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | JOHNSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JOHNSON | ||||||||
| OtherFirstName: | DAWN | ||||||||
| OtherMiddleName: | NICOLE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 18109 PRINCE PHILIP DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | OLNEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208321598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012603292 | ||||||||
| FaxNumber: | 3012603293 | ||||||||
| Practice Location | |||||||||
| Address1: | 4701 OGLETOWN STANTON RD STE 1500 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197137022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234343 | ||||||||
| FaxNumber: | 3026234203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2006 | ||||||||
| LastUpdateDate: | 08/14/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | D0063740 | MD | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD30734 | DC | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | C1-0023818 | DE | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.