Healthcare Provider Details

I. General information

NPI: 1629982400
Provider Name (Legal Business Name): MADISON ELIZABETH LE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S HANOVER ST
BALTIMORE MD
21225-1233
US

IV. Provider business mailing address

300 W REDWOOD ST APT 208
BALTIMORE MD
21201-2339
US

V. Phone/Fax

Practice location:
  • Phone: 410-354-0800
  • Fax:
Mailing address:
  • Phone: 339-927-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberG0000563
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: