Provider Demographics
NPI:1689670325
Name:LEITZEL, AMY L (CNM)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:LEITZEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:KAUFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:3501 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2029
Mailing Address - Country:US
Mailing Address - Phone:410-732-8800
Mailing Address - Fax:410-534-2392
Practice Address - Street 1:900 CATON AVENUE
Practice Address - Street 2:MAILBOX 081
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5299
Practice Address - Country:US
Practice Address - Phone:443-703-3200
Practice Address - Fax:443-703-3201
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR151341176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
S732-J898Medicare ID - Type Unspecified
Q27712Medicare UPIN