Healthcare Provider Details

I. General information

NPI: 1417114208
Provider Name (Legal Business Name): LEONID DUBROVSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 WISCONSIN AVE NW SUITE 200
WASHINGTON DC
20016-2143
US

IV. Provider business mailing address

3250 MCCARROLL DR
BATON ROUGE LA
70809-1515
US

V. Phone/Fax

Practice location:
  • Phone: 267-825-2184
  • Fax:
Mailing address:
  • Phone: 267-825-2184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number300500
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: