Provider Demographics
NPI:1710915111
Name:LEONIDAS, LEONARDO LEONOR (MD)
Entity Type:Individual
Prefix:MR
First Name:LEONARDO
Middle Name:LEONOR
Last Name:LEONIDAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MT HOPE AVE
Mailing Address - Street 2:STE 640
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-947-6739
Mailing Address - Fax:207-942-3554
Practice Address - Street 1:700 MT HOPE AVE
Practice Address - Street 2:STE 640
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-947-6739
Practice Address - Fax:207-942-3554
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME007119208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1042254OtherAETNA
MEM7640COtherCIGNA
ME000037MOtherANTHEM
MEM7640COtherCIGNA