Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | D68922 | MD |
NPI | 1003951823 |
---|---|
Provider Name | Michael Rayner Leedom |
First Address | Baltimore, MD 21201-1642 |
Second Address | Baltimore, MD 21201-1544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 11/02/2013 |