MEDICARE: ARCHANA GOEL LEON-GUERRERO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	D0065924	MD

General Provider Information

NPI Number	:	1053527515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARCHANA GOEL LEON-GUERRERO MD

Provider Business Mailing Address
First Line	:	3375 ELLICOTT CENTER DR
Second Line	:	UNIT 2714
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21041-7501
Country	:	US
Telephone Number	:	410-750-3668
Fax Number	:	410-750-3668

Provider Business Practice Location Address
First Line	:	3375 ELLICOTT CENTER DR
Second Line	:	UNIT 2714
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21041-7501
Country	:	US
Telephone Number	:	410-750-3668
Fax Number	:	410-750-3668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	10/29/2012

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