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NPI Code Detail

MEDICARE: LEISURE WORLD OF MD CORP

MEDICARE: LEISURE WORLD OF MD CORP
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
1333600000XPharmacyP01564MD
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12111172OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1336113463
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEISURE WORLD OF MD CORP
Provider Business Mailing Address
First Line : 3305 N LEISURE WORLD BLVD
Second Line :
City : SILVER SPRING
State : MD
Zip : 20906-1367
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3305 N LEISURE WORLD BLVD
Second Line :
City : SILVER SPRING
State : MD
Zip : 20906-1367
Country : US
Telephone Number : 301-598-1005
Fax Number : 301-598-1548
Authorized Official
Title or Position : ADMINISTRATOR
Name : VIRGINIA BRONAUGH
Credential : PD
Telephone Number : 301-598-1550
Provider Enumeration Date : 02/15/2006
Last Update Date : 09/11/2025

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1972599314 — MRS. KAREN LYNN BASINGER M.S., L.D.N.
Practice Location Address:
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SILVER SPRING, MD
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Practice Fax:
1447220181 — VIRGINIA GAIL BRONAUGH P.D.
Practice Location Address:
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SILVER SPRING, MD
20906-1367
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1932162278 — DR. XIAO-CHUN SHARON YANG MD
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1700841392 — MRS. KATALIN SOLTESZ KOROSSY M.D.
Practice Location Address:
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Practice Fax:

Directions to “LEISURE WORLD OF MD CORP ” Practice Location

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