Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 12586 | MA |
Y | 213EG0000X | General Practice | 12586 | MA |
NPI | 1003817727 |
---|---|
Provider Name | Thomas Michael Leonard |
First Address | Arlington, MA 02474-6733 |
Second Address | Arlington, MA 02474-6733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 08/07/2007 |