Healthcare Provider Details

I. General information

NPI: 1447237003
Provider Name (Legal Business Name): PATRICK LEONG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 FOLEY ST
SOMERVILLE MA
02145-1213
US

IV. Provider business mailing address

440 FOLEY ST
SOMERVILLE MA
02145-1213
US

V. Phone/Fax

Practice location:
  • Phone: 857-282-0777
  • Fax:
Mailing address:
  • Phone: 857-282-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7813
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number151924
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: