Healthcare Provider Details

I. General information

NPI: 1073178125
Provider Name (Legal Business Name): LEONARD EDWARDS HAIGLER SR. PDW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 58TH AVE
FAIRMOUNT HEIGHTS MD
20743-1319
US

IV. Provider business mailing address

703 58TH AVE
FAIRMOUNT HEIGHTS MD
20743-1319
US

V. Phone/Fax

Practice location:
  • Phone: 202-280-4293
  • Fax:
Mailing address:
  • Phone: 202-280-4293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: