Healthcare Provider Details

I. General information

NPI: 1730117730
Provider Name (Legal Business Name): MARK E LEO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 QUAKER LN FL 1
WEST WARWICK RI
02893-2179
US

IV. Provider business mailing address

207 QUAKER LN FL 1
WEST WARWICK RI
02893-2179
US

V. Phone/Fax

Practice location:
  • Phone: 401-828-7110
  • Fax: 401-827-6364
Mailing address:
  • Phone: 401-828-7110
  • Fax: 401-827-6364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number32682
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME156736
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD-46876
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD20890
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: