Provider Demographics
NPI:1124026323
Name:KAZANOV, LEONARD ANATOLY (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:ANATOLY
Last Name:KAZANOV
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 1:5930 FREDERICK CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5137
Mailing Address - Country:US
Mailing Address - Phone:240-379-7776
Mailing Address - Fax:240-379-7787
Practice Address - Street 1:5930 FREDERICK CROSSING LN
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5137
Practice Address - Country:US
Practice Address - Phone:240-379-7776
Practice Address - Fax:240-379-7787
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053809207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
337M 462FMedicare ID - Type Unspecified
G62199Medicare UPIN