Provider Demographics
NPI:1801823729
Name:SOTO, LELAND J III (MD)
Entity Type:Individual
Prefix:
First Name:LELAND
Middle Name:J
Last Name:SOTO
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:67 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1328
Mailing Address - Country:US
Mailing Address - Phone:203-732-1330
Mailing Address - Fax:203-732-1332
Practice Address - Street 1:350 SEYMOUR AVE STE 101
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1336
Practice Address - Country:US
Practice Address - Phone:203-732-3443
Practice Address - Fax:855-287-1988
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT043520208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT020001632Medicare UPIN
H57658Medicare UPIN