Provider Demographics
NPI:1598532392
Name:SONNENBERG, LEORA (LE)
Entity Type:Individual
Prefix:
First Name:LEORA
Middle Name:
Last Name:SONNENBERG
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 OLD COURT RD STE 412
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3908
Mailing Address - Country:US
Mailing Address - Phone:410-301-3667
Mailing Address - Fax:
Practice Address - Street 1:3635 OLD COURT RD STE 412
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3908
Practice Address - Country:US
Practice Address - Phone:410-301-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8A2C8F174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist