Provider Demographics
NPI:1912945312
Name:DE LEON, DINA REA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:REA
Last Name:DE LEON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 NORTH ST STE A
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5505
Mailing Address - Country:US
Mailing Address - Phone:410-398-8899
Mailing Address - Fax:410-398-1477
Practice Address - Street 1:215 NORTH ST STE A
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5505
Practice Address - Country:US
Practice Address - Phone:410-398-8899
Practice Address - Fax:410-398-1477
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060808208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404426600Medicaid
MDI12120Medicare UPIN