Provider Demographics
NPI:1134625221
Name:OLIVEIRA, LEONARDO (MD)
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:OLIVEIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 CHESTNUT ST STE A
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-2495
Mailing Address - Country:US
Mailing Address - Phone:973-902-3116
Mailing Address - Fax:580-297-9263
Practice Address - Street 1:374 CHESTNUT ST STE A
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2495
Practice Address - Country:US
Practice Address - Phone:973-902-3116
Practice Address - Fax:802-979-2635
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10973200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine