Provider Demographics
NPI:1043616360
Name:SANDRA LENI, MD, LLC
Entity Type:Organization
Organization Name:SANDRA LENI, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-428-0528
Mailing Address - Street 1:645 BALTIMORE ANNAPOLIS BOULEVARD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146
Mailing Address - Country:US
Mailing Address - Phone:240-428-0528
Mailing Address - Fax:
Practice Address - Street 1:645 BALTIMORE ANNAPOLIS BOULEVARD
Practice Address - Street 2:SUITE 213
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146
Practice Address - Country:US
Practice Address - Phone:240-428-0528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
MDD0071495314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD550010900Medicaid
MD550010900Medicaid