Provider Demographics
NPI:1730125634
Name:BRASCH, LEAH (MD)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:BRASCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 N PARK AVE
Mailing Address - Street 2:SUITE 8C
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4519
Mailing Address - Country:US
Mailing Address - Phone:301-656-2745
Mailing Address - Fax:301-718-7681
Practice Address - Street 1:4601 N PARK AVE
Practice Address - Street 2:SUITE 8C
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4519
Practice Address - Country:US
Practice Address - Phone:301-656-2745
Practice Address - Fax:301-718-7681
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036558208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402481800Medicaid