Provider Demographics
NPI:1760640684
Name:SHAO, LEON Z (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:Z
Last Name:SHAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:252 CHAPMEN ROAD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:252 CHAPMAN ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-1094
Practice Address - Country:US
Practice Address - Phone:302-366-1929
Practice Address - Fax:302-366-1075
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233143207R00000X
DEC1-0010962207RC0000X, 207RI0011X, 207R00000X
PAMD441912207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology