Provider Demographics
NPI:1982836904
Name:GIRIO-HERRERA, LEONARDO (DO)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:GIRIO-HERRERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10845 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1717
Mailing Address - Country:US
Mailing Address - Phone:410-335-0008
Mailing Address - Fax:410-335-3113
Practice Address - Street 1:520 UPPER CHESAPEAKE DR
Practice Address - Street 2:SUITE 312
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4339
Practice Address - Country:US
Practice Address - Phone:443-643-2236
Practice Address - Fax:443-643-1545
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH79486207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD414109ZPESOtherMEDICARE
DCBX93-0000OtherCAREFIRST
MD641012000OtherMEDICAL ASSISTANCE
GAP01508037OtherRAILROAD MEDICARE
MDBX93-0000OtherCAREFIRST