Provider Demographics
NPI:1447548409
Name:DEFUSCO, LEONARD (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:DEFUSCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 CEDAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1815
Mailing Address - Country:US
Mailing Address - Phone:860-646-9859
Mailing Address - Fax:860-646-9859
Practice Address - Street 1:177 CEDAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1815
Practice Address - Country:US
Practice Address - Phone:860-646-9859
Practice Address - Fax:860-646-9859
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT012548174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist