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General NPI Number Information
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NPI Number | 1003889866
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Entity Type | Individual
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Provider Name | CHARLES J. LEIDNER MD
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 55 HIGHLAND AVUENE SUITE 201
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City | SALEM
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State | MA
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Zip | 01970
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Country | US
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Telephone | 978-745-6601
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Fax | 978-744-4872
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Provider Business Mailing Address
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Address Line | 12 PHILLIPS BEACH AVENUE
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City | SWAMPSCOTT
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State | MA
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Zip | 01907
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Country | US
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Telephone | 781-599-1915
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 41165
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License Number State | MA
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