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NPI Code Detail

MEDICARE: DR. MARK MICHAEL LEYNGOLD MD

MEDICARE: DR. MARK MICHAEL LEYNGOLD 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
1208200000XPlastic Surgery PhysicianME116419FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
220024303OTHERIDMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093839003
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK MICHAEL LEYNGOLD MD
Provider Business Mailing Address
First Line : 3015 E GOLDSTONE DR # 130
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-1549
Country : US
Telephone Number : 208-900-4673
Fax Number : 208-266-5033
Provider Business Practice Location Address
First Line : 3015 E GOLDSTONE DR # 130
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-1549
Country : US
Telephone Number : 208-900-4673
Fax Number : 208-266-5033
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 11/10/2022

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