Basic Information
| Provider Information | |||||||||
| NPI: | 1194710517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | LOC | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1838 GREENE TREE RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212086391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106027782 | ||||||||
| FaxNumber: | 4106022438 | ||||||||
| Practice Location | |||||||||
| Address1: | 1838 GREENE TREE RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212086391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106027782 | ||||||||
| FaxNumber: | 4106022438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 03/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | M30908 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | D39528 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.