Healthcare Provider Details

I. General information

NPI: 1295933992
Provider Name (Legal Business Name): LEIGH JESSICA MARCUS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST CMSC 800
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

14730 FOURTH STREET APT 442
LAUREL MD
20707-3749
US

V. Phone/Fax

Practice location:
  • Phone: 410-614-5055
  • Fax:
Mailing address:
  • Phone: 240-786-7243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number0450889
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: