Provider Demographics
NPI:1922089952
Name:LEONG, REBECCA J (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:LEONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WESTWAY RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-2807
Mailing Address - Country:US
Mailing Address - Phone:508-358-3432
Mailing Address - Fax:
Practice Address - Street 1:22 WESTWAY RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-2807
Practice Address - Country:US
Practice Address - Phone:508-358-3432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71309207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3106101Medicaid
MAJ13480Medicare ID - Type Unspecified
MA3106101Medicaid