Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 12421 | MA |
NPI | 1003825936 |
---|---|
Provider Name | Dr. Richard Neil Leaderman |
First Address | West Springfield, MA 01089-1847 |
Second Address | W Springfield, MA 01089-1847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 08/07/2007 |