Basic Information
| Provider Information | |||||||||
| NPI: | 1184970550 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEACH | ||||||||
| FirstName: | NATHANIEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | CRT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1406 BANKERT TERRACE | ||||||||
| Address2: | |||||||||
| City: | ABINGDON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435003476 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 NORTH GREEN ST. | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106057000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2012 | ||||||||
| LastUpdateDate: | 10/08/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227800000X | L0000881 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | 2278C0205X | L0000881 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Critical Care |
No ID Information.