Provider Demographics
NPI:1346287919
Name:LEONARD, MARK T (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:LEONARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1870 AMHERST ST
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-667-4546
Mailing Address - Fax:540-667-6893
Practice Address - Street 1:1870 AMHERST ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-667-4546
Practice Address - Fax:540-667-6893
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101055051207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006209700Medicaid
WV0093405000Medicaid
WV0093405000Medicaid