Provider Demographics
NPI:1912178377
Name:LEONARD WISOTSKY
Entity Type:Organization
Organization Name:LEONARD WISOTSKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WISOTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-567-5005
Mailing Address - Street 1:6188 OXON HILL RD
Mailing Address - Street 2:SUITE 804
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3113
Mailing Address - Country:US
Mailing Address - Phone:301-567-5005
Mailing Address - Fax:301-839-5677
Practice Address - Street 1:6188 OXON HILL RD
Practice Address - Street 2:SUITE 804
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3113
Practice Address - Country:US
Practice Address - Phone:301-567-5005
Practice Address - Fax:301-839-5677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD08378OtherAMERIGROUP
MD27496OtherPRIORITY PARTNERS
MDP00152532OtherRAILROAD MEDICARE
MDP00152532OtherRAILROAD MEDICARE
DC065061Medicare PIN
DCT30833Medicare UPIN
MD420QMedicare PIN