Basic Information
| Provider Information | |||||||||
| NPI: | 1588287254 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEEDER | ||||||||
| FirstName: | MARCO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 VIEW ST | ||||||||
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| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041031023 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 41 MALL RD | ||||||||
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| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018052656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817448000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2020 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN2279000 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.