Provider Demographics
NPI:1578012118
Name:LEIBOWITZ, BLAKE (PA-C)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:LEIBOWITZ
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2730 UNIVERSITY BLVD W STE 310
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1990
Mailing Address - Country:US
Mailing Address - Phone:301-942-7600
Mailing Address - Fax:301-942-3521
Practice Address - Street 1:14995 SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8726
Practice Address - Country:US
Practice Address - Phone:301-942-7600
Practice Address - Fax:301-217-9241
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2022-03-25
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant