Provider Demographics
NPI:1205154523
Name:DE LEON, LAUREN MICHAL (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MICHAL
Last Name:DE LEON
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 1:10 DAVOL SQ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4754
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:41 SANDERSON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2602
Practice Address - Country:US
Practice Address - Phone:401-949-0300
Practice Address - Fax:401-349-3387
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD14240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
003413601OtherMEDICARE PTAN
709004048OtherMEDICARE GROUP
RILD93741Medicaid