Healthcare Provider Details

I. General information

NPI: 1629384581
Provider Name (Legal Business Name): LEONARD JOHN GIUFFREDA III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2010
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S CATON AVE
BALTIMORE MD
21229-5201
US

IV. Provider business mailing address

244 GRAY FOX CT
EDGEWATER MD
21037-2733
US

V. Phone/Fax

Practice location:
  • Phone: 410-368-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.207957
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.207957
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberP25907
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: