Healthcare Provider Details

I. General information

NPI: 1982836904
Provider Name (Legal Business Name): LEONARDO GIRIO-HERRERA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 UPPER CHESAPEAKE DR SUITE 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 NumberH79486
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: