Healthcare Provider Details

I. General information

NPI: 1538715990
Provider Name (Legal Business Name): ALEXANDRA LEONARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W RIVER ST STE 1B
PROVIDENCE RI
02904-2615
US

IV. Provider business mailing address

148 W RIVER ST STE 1B
PROVIDENCE RI
02904-2615
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-9310
  • Fax:
Mailing address:
  • Phone: 401-273-9310
  • Fax: 401-273-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD19302
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1015016
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: