Healthcare Provider Details

I. General information

NPI: 1427435692
Provider Name (Legal Business Name): LEONARDO GIRIO-HERRERA, D.O., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 UPPER CHESAPEAKE DR 312
BEL AIR MD
21014-4339
US

IV. Provider business mailing address

10845 PHILADELPHIA RD
WHITE MARSH MD
21162-1717
US

V. Phone/Fax

Practice location:
  • Phone: 443-643-2236
  • Fax: 443-643-1545
Mailing address:
  • Phone: 410-335-0008
  • Fax: 410-335-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LEONARDO GIRIO-HERRERA
Title or Position: OWNER
Credential: D.O.
Phone: 410-335-0008