Provider Demographics
NPI:1811461643
Name:PFISTER, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:PFISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:THURMONT
Mailing Address - State:MD
Mailing Address - Zip Code:21788-1641
Mailing Address - Country:US
Mailing Address - Phone:240-397-0209
Mailing Address - Fax:
Practice Address - Street 1:7407 WILLOW RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-2500
Practice Address - Country:US
Practice Address - Phone:301-644-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07304208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP236493585351OtherDMV
MD07304OtherMD OT BOARD