Provider Demographics
NPI:1760078844
Name:JEROME, LEONDER R
Entity Type:Individual
Prefix:
First Name:LEONDER
Middle Name:R
Last Name:JEROME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10901 DANIEL SIM CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-7424
Mailing Address - Country:US
Mailing Address - Phone:240-386-9979
Mailing Address - Fax:
Practice Address - Street 1:10901 DANIEL SIM CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-7424
Practice Address - Country:US
Practice Address - Phone:240-386-9979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide