Healthcare Provider Details

I. General information

NPI: 1376986208
Provider Name (Legal Business Name): WAYNE KEITH LEUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST # 8534-8S
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

1800 ORLEANS ST RM 8534-8S
BALTIMORE MD
21287-0010
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5259
  • Fax:
Mailing address:
  • Phone: 410-955-5259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101260155
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberD83261
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: