Healthcare Provider Details

I. General information

NPI: 1861453581
Provider Name (Legal Business Name): LEIGH E MATLAGA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1576 MERRITT BLVD SUITE 3
BALTIMORE MD
21222-2132
US

IV. Provider business mailing address

1576 MERRITT BLVD SUITE 3
BALTIMORE MD
21222-2132
US

V. Phone/Fax

Practice location:
  • Phone: 410-650-2191
  • Fax:
Mailing address:
  • Phone: 410-650-2191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0064001
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: