Provider Demographics
NPI:1033142393
Name:LEONARD SAX MD PHD PA
Entity Type:Organization
Organization Name:LEONARD SAX MD PHD PA
Other - Org Name:POOLESVILLE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:301-972-7600
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:POOLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20837-0108
Mailing Address - Country:US
Mailing Address - Phone:301-972-7600
Mailing Address - Fax:301-972-8006
Practice Address - Street 1:19710 FISHER AVE
Practice Address - Street 2:SUITE J
Practice Address - City:POOLESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20837-2098
Practice Address - Country:US
Practice Address - Phone:301-972-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC34124Medicare UPIN
MD595277Medicare ID - Type Unspecified