Provider Demographics
NPI:1831126572
Name:LEICHTLING, DAVID MILTON (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MILTON
Last Name:LEICHTLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5450 KNOLL NORTH DRIVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2300
Mailing Address - Country:US
Mailing Address - Phone:410-964-6200
Mailing Address - Fax:410-964-6392
Practice Address - Street 1:5450 KNOLL NORTH DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:41045-2300
Practice Address - Country:US
Practice Address - Phone:410-964-6200
Practice Address - Fax:410-964-6392
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0029888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD380561100Medicaid
MDP00273944OtherMEDICARE RAILROAD
MDP00273944OtherMEDICARE RAILROAD
MDB67274Medicare UPIN
MD380561100Medicaid