Healthcare Provider Details

I. General information

NPI: 1730454372
Provider Name (Legal Business Name): SIMON LEUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

9014 PINEY BRANCH RD APT 104
SILVER SPRING MD
20903-2721
US

V. Phone/Fax

Practice location:
  • Phone: 202-806-7981
  • Fax:
Mailing address:
  • Phone: 202-806-7967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number207730
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: