Provider Demographics
NPI:1427435692
Name:LEONARDO GIRIO-HERRERA, D.O., L.L.C.
Entity type:Organization
Organization Name:LEONARDO GIRIO-HERRERA, D.O., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRIO-HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-335-0008
Mailing Address - Street 1:10845 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1717
Mailing Address - Country:US
Mailing Address - Phone:410-335-0008
Mailing Address - Fax:410-335-3113
Practice Address - Street 1:520 UPPER CHESAPEAKE DR
Practice Address - Street 2:312
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4339
Practice Address - Country:US
Practice Address - Phone:443-643-2236
Practice Address - Fax:443-643-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD414106OtherMEDICARE
MDBX93OtherCAREFIRST
DCBX93OtherCAREFIRST
GADV8721OtherRAILROAD MEDICARE