Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | D37089 | MD |
N | 111NI0900X | Internist | D37089 | MD |
Y | 207RG0300X | Geriatric Medicine | D37089 | MD |
NPI | 1164466157 |
---|---|
Provider Name | Bruce Leff |
First Address | Baltimore, MD 21264-4264 |
Second Address | Baltimore, MD 21224-6821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 11/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
286981100 | (05) | MD |
D77549 | (02) | MD |