Provider Demographics
NPI:1821236852
Name:LEYDEN, JAN E (MD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:E
Last Name:LEYDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 POND AVE
Mailing Address - Street 2:#342
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7129
Mailing Address - Country:US
Mailing Address - Phone:617-708-4568
Mailing Address - Fax:
Practice Address - Street 1:99 POND AVE
Practice Address - Street 2:#342
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7129
Practice Address - Country:US
Practice Address - Phone:617-708-4568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238315390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program