Basic Information
| Provider Information | |||||||||
| NPI: | 1538120647 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEONARD | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | EDWIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11701 LIVINGSTON RD | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | FORT WASHINGTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207445146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012927200 | ||||||||
| FaxNumber: | 3018567815 | ||||||||
| Practice Location | |||||||||
| Address1: | 11701 LIVINGSTON ROAD | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | FORT WASHINGTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207445146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012927200 | ||||||||
| FaxNumber: | 3018567815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 12/06/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | G55108 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | D69242 | MD | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.