Provider Demographics
NPI:1871571976
Name:LEONARD SURGICAL CARE ASSOCIATES, LLC
Entity type:Organization
Organization Name:LEONARD SURGICAL CARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-694-5154
Mailing Address - Street 1:501 W SEVENTH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4507
Mailing Address - Country:US
Mailing Address - Phone:301-694-5154
Mailing Address - Fax:301-694-5205
Practice Address - Street 1:501 W SEVENTH ST
Practice Address - Street 2:SUITE D
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4507
Practice Address - Country:US
Practice Address - Phone:301-694-5154
Practice Address - Fax:301-694-5205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD63740208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD649360-01OtherCAREFIRST OF MD
MD2153974OtherONE NET, PPO
MD5680032OtherFIRST HEALTH
2153974OtherOPTIMUM CHOICE
MD2153974OtherMD IPA
MDN109-0001OtherCAREFIRST NCA
MD5680032OtherFIRST HEALTH
MD2153974OtherMD IPA