1164429429 NPI number — RICHARD T LESCHEK D.O.

Table of content: RICHARD T LESCHEK D.O. (NPI 1164429429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164429429 NPI number — RICHARD T LESCHEK D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LESCHEK
Provider First Name:
RICHARD
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164429429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
172 THOMAS JOHNSON DR
Provider Second Line Business Mailing Address:
202
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21702-4402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-698-8300
Provider Business Mailing Address Fax Number:
301-698-8389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
172 THOMAS JOHNSON DR
Provider Second Line Business Practice Location Address:
202
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-698-8300
Provider Business Practice Location Address Fax Number:
301-698-8389
Provider Enumeration Date:
07/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  H45306 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 53050409 . This is a "BCBS LOCAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 613557 . This is a "MDIPA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2120058 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0002 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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