Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | D84474 | MD |
NPI | 1013206119 |
---|---|
Provider Name | Thorsten Martin Leucker |
First Address | Baltimore, MD 21236-4902 |
Second Address | Baltimore, MD 21224-2735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2011 |
Last Update Date | 09/02/2018 |