Provider Demographics
NPI:1710944822
Name:SMALL, LEONARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:M
Last Name:SMALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14 MENDUMS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825-3000
Mailing Address - Country:US
Mailing Address - Phone:603-742-4048
Mailing Address - Fax:603-743-3345
Practice Address - Street 1:17 OLD ROLLINSFORD RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2833
Practice Address - Country:US
Practice Address - Phone:603-742-4048
Practice Address - Fax:603-743-3345
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH6040208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHG30906Medicare UPIN
NH00000524Medicare ID - Type UnspecifiedNH MEDICAID PROVIDER #