Healthcare Provider Details

I. General information

NPI: 1477544344
Provider Name (Legal Business Name): LEO L SHUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 RESEARCH BLVD 350
ROCKVILLE MD
20850-6211
US

IV. Provider business mailing address

4720 HORNBEAM DR
ROCKVILLE MD
20853-1419
US

V. Phone/Fax

Practice location:
  • Phone: 301-330-6983
  • Fax: 301-330-6984
Mailing address:
  • Phone: 301-570-9700
  • Fax: 301-260-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberD60557
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0060557
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: