Provider Demographics
NPI:1497707566
Name:LEACH, KADIE E (MD)
Entity Type:Individual
Prefix:
First Name:KADIE
Middle Name:E
Last Name:LEACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9500 ANNAPOLIS RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2060
Mailing Address - Country:US
Mailing Address - Phone:301-577-5818
Mailing Address - Fax:301-577-4120
Practice Address - Street 1:9500 ANNAPOLIS RD
Practice Address - Street 2:SUITE A1
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2060
Practice Address - Country:US
Practice Address - Phone:301-577-5818
Practice Address - Fax:301-577-4120
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0027521207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD329221500Medicaid
MD329221500Medicaid
MD521681834OtherTIN
MD329221500Medicaid