Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 4045 | MD |
NPI | 1043540131 |
---|---|
Provider Name | Dr. James Nicholas Leyko |
First Address | Perry Hall, MD 21128-9849 |
Second Address | Perry Hall, MD 21128-9849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2010 |
Last Update Date | 19/01/2010 |