Healthcare Provider Details

I. General information

NPI: 1649205337
Provider Name (Legal Business Name): DEBRA G. LEONARD MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVENUE, MAIL STOP 233MP1
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVENUE, MAIL STOP 233MP1
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-6124
  • Fax: 802-847-3509
Mailing address:
  • Phone: 802-847-6124
  • Fax: 802-847-3509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number181078
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number042.0012569
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number042.0012569
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: