Provider Demographics
NPI:1659531077
Name:MEDLOCK, LEIA M (MD)
Entity Type:Individual
Prefix:
First Name:LEIA
Middle Name:M
Last Name:MEDLOCK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8630M GUILFORD RD
Mailing Address - Street 2:STE 288
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1404
Mailing Address - Country:US
Mailing Address - Phone:301-414-2300
Mailing Address - Fax:301-414-2306
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4114
Practice Address - Country:US
Practice Address - Phone:240-554-5505
Practice Address - Fax:240-280-7472
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2023-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT193601207V00000X
MDD0074550207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology