Provider Demographics
NPI:1245496041
Name:EDWARD LEONARD II MD PS
Entity type:Organization
Organization Name:EDWARD LEONARD II MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:425-899-3999
Mailing Address - Street 1:1200 116TH AVE NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3802
Mailing Address - Country:US
Mailing Address - Phone:425-455-8248
Mailing Address - Fax:
Practice Address - Street 1:1200 116TH AVE NE
Practice Address - Street 2:SUITE D
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3802
Practice Address - Country:US
Practice Address - Phone:425-455-8248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033910174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8851878Medicare PIN