Healthcare Provider Details

I. General information

NPI: 1760528038
Provider Name (Legal Business Name): LEON FRANKLIN BOOKER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4419 FALLS RD STE A
BALTIMORE MD
21211-1298
US

IV. Provider business mailing address

PO BOX 16311
BALTIMORE MD
21210
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-0022
  • Fax: 410-366-0322
Mailing address:
  • Phone: 410-366-0022
  • Fax: 410-366-0322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1124
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier346478400
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: