Provider Demographics
NPI:1275220568
Name:LEON, MARIA D (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:LEON
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-1742
Mailing Address - Country:US
Mailing Address - Phone:610-739-2306
Mailing Address - Fax:
Practice Address - Street 1:469 N 7TH ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-1742
Practice Address - Country:US
Practice Address - Phone:610-739-2306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007522133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered