Provider Demographics
NPI:1508268244
Name:LECLERC, MARCO TIMOTHY (MAOM)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:TIMOTHY
Last Name:LECLERC
Suffix:
Gender:M
Credentials:MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 EAST ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-1802
Mailing Address - Country:US
Mailing Address - Phone:401-212-7816
Mailing Address - Fax:
Practice Address - Street 1:21 EAST ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-1802
Practice Address - Country:US
Practice Address - Phone:401-212-7816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist