Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | DOOO6812 | MD |
NPI | 1134363500 |
---|---|
Provider Name | Ferdinand S. Leacock |
First Address | Annapolis, MD 21403-4852 |
Second Address | Annapolis, MD 21403-4852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2009 |
Last Update Date | 28/04/2009 |