Provider Demographics
NPI:1912180258
Name:MID MARYLAND NEUROLOGY, PA
Entity Type:Organization
Organization Name:MID MARYLAND NEUROLOGY, PA
Other - Org Name:DWYER AND LESCHEK, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:LESCHEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-698-8300
Mailing Address - Street 1:172 THOMAS JOHNSON DR
Mailing Address - Street 2:202
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4402
Mailing Address - Country:US
Mailing Address - Phone:301-698-8300
Mailing Address - Fax:301-698-8389
Practice Address - Street 1:172 THOMAS JOHNSON DR
Practice Address - Street 2:202
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4402
Practice Address - Country:US
Practice Address - Phone:301-698-8300
Practice Address - Fax:301-698-8389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
492MMedicare PIN