Healthcare Provider Details

I. General information

NPI: 1073811857
Provider Name (Legal Business Name): LANCE G. LEITHAUSER, M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9715 MEDICAL CENTER DR SUITE 535
ROCKVILLE MD
20850-3320
US

IV. Provider business mailing address

9715 MEDICAL CENTER DR SUITE 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: LANCE G. LEITHAUSER
Title or Position: M.D.
Credential: M.D.
Phone: 301-294-9400