Provider Demographics
NPI:1902185341
Name:LEADER, BENJAMIN SIMON (MD, PHD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SIMON
Last Name:LEADER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 TRADECENTER
Mailing Address - Street 2:REPROSOURCE INC. SUITE 6540
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1883
Mailing Address - Country:US
Mailing Address - Phone:617-312-8659
Mailing Address - Fax:
Practice Address - Street 1:300 TRADECENTER
Practice Address - Street 2:REPROSOURCE INC. SUITE 6540
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1883
Practice Address - Country:US
Practice Address - Phone:617-312-8659
Practice Address - Fax:617-507-8446
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RILR22968-24196-LP0022207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine