Provider Demographics
NPI:1104982651
Name:PROCTOR, LEONARD R (MD)
Entity type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:R
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:520 UPPER CHESAPEAKE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4339
Mailing Address - Country:US
Mailing Address - Phone:410-879-9100
Mailing Address - Fax:410-879-0227
Practice Address - Street 1:520 UPPER CHESAPEAKE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4339
Practice Address - Country:US
Practice Address - Phone:410-879-9100
Practice Address - Fax:410-879-0227
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0020022207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD498841OtherNCAS
MD2238291OtherAETNA HMO
MD4669138OtherAETNA PPO
MD34735011OtherBLUE SHIELD OF MD
MD82012000Medicaid
DCE5130006OtherBLUECHOICE
MD82012000Medicaid
MDD74463Medicare UPIN