Healthcare Provider Details

I. General information

NPI: 1689670325
Provider Name (Legal Business Name): AMY L LEITZEL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY L KAUFFMAN CNM

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CATON AVENUE MAILBOX 081
BALTIMORE MD
21229-5299
US

IV. Provider business mailing address

3501 SINCLAIR LN
BALTIMORE MD
21213-2029
US

V. Phone/Fax

Practice location:
  • Phone: 443-703-3200
  • Fax: 443-703-3201
Mailing address:
  • Phone: 410-732-8800
  • Fax: 410-534-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberR151341
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: