MEDICARE: DR. FERNANDO C DE LEON M.D.

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	207R00000X	Internal Medicine Physician	D0046120	MD
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	D0046120	MD
3	207RP1001X	Pulmonary Disease Physician	D0046120	MD

General Provider Information

NPI Number	:	1922003060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERNANDO C DE LEON M.D.

Provider Business Mailing Address
First Line	:	920 ELKRIDGE LANDING RD
Second Line	:	STE 310
City	:	LINTHICUM
State	:	MD
Zip	:	21090-2917
Country	:	US
Telephone Number	:	443-462-5010
Fax Number	:	410-684-2031

Provider Business Practice Location Address
First Line	:	10710 CHARTER DRIVE
Second Line	:	STE 310
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3260
Country	:	US
Telephone Number	:	410-997-5944
Fax Number	:	410-997-1720

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/18/2016

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