Basic Information
Provider Information
NPI: 1003007824
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SOWAH
FirstName: LEONARD
MiddleName: ANANG
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 64442
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212644442
CountryCode: US
TelephoneNumber: 4107064613
FaxNumber: 4107064619
Practice Location
Address1: 22 S GREENE ST
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212011544
CountryCode: US
TelephoneNumber: 4107064619
FaxNumber: 4107062062
Other Information
ProviderEnumerationDate: 08/06/2007
LastUpdateDate: 08/09/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X036117582ILN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000XD66464MDY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
51036140005MD MEDICAID


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