Provider Demographics
NPI:1730117730
Name:LEO, MARK E (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:LEO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:207 QUAKER LN FL 1
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-2179
Mailing Address - Country:US
Mailing Address - Phone:401-828-7110
Mailing Address - Fax:401-827-6364
Practice Address - Street 1:207 QUAKER LN FL 1
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-2179
Practice Address - Country:US
Practice Address - Phone:401-828-7110
Practice Address - Fax:401-827-6364
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2025-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN32682208800000X
FLME156736208800000X
IAMD-46876208800000X
RIMD20890208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV340012386OtherRAILROAD MEDICARE PIN
NV002019012Medicaid
NV002019012Medicaid
NV340012386OtherRAILROAD MEDICARE PIN