Healthcare Provider Details

I. General information

NPI: 1013918184
Provider Name (Legal Business Name): LANCE G LEITHAUSER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9715 MEDICAL CENTER DR 535
ROCKVILLE MD
20850-3320
US

IV. Provider business mailing address

9715 MEDICAL CENTER DR 535
ROCKVILLE MD
20850-3320
US

V. Phone/Fax

Practice location:
  • Phone: 301-294-9400
  • Fax: 301-294-0149
Mailing address:
  • Phone: 301-294-9400
  • Fax: 301-294-0149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberD0021581
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: