Provider Demographics
NPI:1093725616
Name:DEV, LEENA SHRIVASTAVA (MD)
Entity Type:Individual
Prefix:
First Name:LEENA
Middle Name:SHRIVASTAVA
Last Name:DEV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 THOMAS JOHNSON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4427
Mailing Address - Country:US
Mailing Address - Phone:301-694-0606
Mailing Address - Fax:301-662-6928
Practice Address - Street 1:87 THOMAS JOHNSON DR STE 101
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4427
Practice Address - Country:US
Practice Address - Phone:301-694-0606
Practice Address - Fax:301-662-6928
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070491208000000X, 208M00000X
NJ25MA08917600208000000X
MDD0075515208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD422391800Medicaid
NJ0188077Medicaid
MI4710765Medicaid
MI4710765Medicaid