Provider Demographics
NPI:1538120647
Name:LEONARD, KENNETH EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EDWIN
Last Name:LEONARD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11701 LIVINGSTON RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5146
Mailing Address - Country:US
Mailing Address - Phone:301-292-7200
Mailing Address - Fax:301-856-7815
Practice Address - Street 1:11701 LIVINGSTON ROAD
Practice Address - Street 2:SUITE 308
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5146
Practice Address - Country:US
Practice Address - Phone:301-292-7200
Practice Address - Fax:301-856-7815
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2011-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG55108208600000X
MDD69242208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF99165Medicare UPIN