Healthcare Provider Details

I. General information

NPI: 1033887476
Provider Name (Legal Business Name): RIVKA R LEICHTER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 CHARTER DR STE G030
COLUMBIA MD
21044-3261
US

IV. Provider business mailing address

6809 CHIPPEWA DR
BALTIMORE MD
21209-1434
US

V. Phone/Fax

Practice location:
  • Phone: 443-546-1300
  • Fax:
Mailing address:
  • Phone: 410-484-8355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR185521
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: