Provider Demographics
NPI:1881671469
Name:OWENS, LEROY ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:ANTHONY
Last Name:OWENS
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 1:11701 LIVINGSTON RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5104
Mailing Address - Country:US
Mailing Address - Phone:301-292-0192
Mailing Address - Fax:301-292-5490
Practice Address - Street 1:11701 LIVINGSTON RD
Practice Address - Street 2:SUITE 307
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5104
Practice Address - Country:US
Practice Address - Phone:301-292-0192
Practice Address - Fax:301-292-5490
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030129208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics