Healthcare Provider Details

I. General information

NPI: 1033417357
Provider Name (Legal Business Name): LEON VANDENBERG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

600 VIERLING DR
SILVER SPRING MD
20904-1011
US

IV. Provider business mailing address

600 VIERLING DR
SILVER SPRING MD
20904-1011
US

V. Phone/Fax

Practice location:
  • Phone: 301-384-0791
  • Fax:
Mailing address:
  • Phone: 301-384-0791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number07648
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: