Healthcare Provider Details

I. General information

NPI: 1699826875
Provider Name (Legal Business Name): RALPH ELI LEBLANC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 LIGHT ST
BALTIMORE MD
21230-3850
US

IV. Provider business mailing address

726 LIGHT ST
BALTIMORE MD
21230-3850
US

V. Phone/Fax

Practice location:
  • Phone: 410-528-1400
  • Fax: 410-528-1407
Mailing address:
  • Phone: 304-813-8332
  • Fax: 443-869-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0025411
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: