Provider Demographics
NPI:1710999511
Name:LEONARDO, JOHN LANCELOT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LANCELOT
Last Name:LEONARDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1711 CUDABACK AVENUE
Mailing Address - Street 2:PMB 942825
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14303-1709
Mailing Address - Country:US
Mailing Address - Phone:646-675-7622
Mailing Address - Fax:
Practice Address - Street 1:1711 CUDABACK AVENUE
Practice Address - Street 2:PMB 942825
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14303-1709
Practice Address - Country:US
Practice Address - Phone:646-675-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08096800207L00000X
NY239613-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology