Provider Demographics
NPI:1982804241
Name:HSIAO, LEAL (MD)
Entity Type:Individual
Prefix:
First Name:LEAL
Middle Name:
Last Name:HSIAO
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 1:3720 FARRAGUT AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2152
Mailing Address - Country:US
Mailing Address - Phone:301-949-4242
Mailing Address - Fax:
Practice Address - Street 1:3720 FARRAGUT AVE FL 2
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2152
Practice Address - Country:US
Practice Address - Phone:301-949-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC130807207Q00000X
MA243268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110085418AMedicaid
MA110085418AMedicaid