Provider Demographics
NPI:1740386044
Name:ODEMENA, LEONA (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEONA
Middle Name:
Last Name:ODEMENA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BRAMBLE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2471
Mailing Address - Country:US
Mailing Address - Phone:443-225-6640
Mailing Address - Fax:443-225-6641
Practice Address - Street 1:100 BRAMBLE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2471
Practice Address - Country:US
Practice Address - Phone:443-225-6640
Practice Address - Fax:443-225-6641
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01443213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5849300001OtherDURABLE MEDICAL EQUIPMENT (DME) PTAN
MD172837OtherMEDICARE TPAN
MD172837OtherMEDICARE TPAN