Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | D0021581 | MD |
Y | 208600000X | Surgeon | D0021581 | MD |
NPI | 1013918184 |
---|---|
Provider Name | Dr. Lance G Leithauser |
First Address | Rockville, MD 20850-3320 |
Second Address | Rockville, MD 20850-3320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 03/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05008 | AMERIGROUP (01) | MD |
0819656 | AETNA (01) | MD |
189061100 | (05) | MD |
20071 | MAMSI (01) | MD |
41680702 | CF BC/BS MD (01) | MD |
9440-0001 | CF BC/BS NCA (01) | MD |
B94611 | (02) | MD |