MEDICARE: MISS MONICA RENEE LEID PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	C0004455	MD

General Provider Information

NPI Number	:	1013280916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MONICA RENEE LEID PA-C

Provider Business Mailing Address
First Line	:	201 DEFENSE HWY STE 205
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7096
Country	:	US
Telephone Number	:	855-527-7246
Fax Number	:	866-229-5063

Provider Business Practice Location Address
First Line	:	3261 OLD WASHINGTON RD STE 3010
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-3229
Country	:	US
Telephone Number	:	855-527-7246
Fax Number	:	866-229-5063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	04/18/2025

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