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General NPI Number Information
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NPI Number | 1205958675
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Entity Type | Organization
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Legal Business Name | SOPHIA LEONIDA M.D., PC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 2505 MAIN ST.
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City | STRATFORD
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State | CT
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Zip | 06615
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Country | US
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Telephone | 203-375-9350
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Fax | 203-375-8013
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Provider Business Mailing Address
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Address Line | 2505 MAIN ST.
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City | STRATFORD
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State | CT
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Zip | 06615
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Country | US
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Telephone | 203-375-9350
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Fax | 203-375-8013
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Authorized Official
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Title or Position | OWNER
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Name | DR. SOPHIA V. LEONIDA
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Credential | M.D.
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Telephone | 203-375-9350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 023160
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License Number State | CT
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