Active NPI
Leonard R Proctor, M.D.
- Otolaryngology Physician
- Bel Air, MD
National Provider Identifier
1104982651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- D0020022
- Practice address
- 520 Upper Chesapeake Dr
Suite 206
Bel Air, MD 21014-4339 - Phone
- (410) 879-9100
- Fax
- (410) 879-0227
- NPI assigned
- Dec 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | D0020022 | MD | Primary |
Addresses
Primary practice location
520 Upper Chesapeake Dr
Suite 206
Bel Air, MD 21014-4339
Mailing address
520 Upper Chesapeake Dr
Suite 206
Bel Air, MD 21014-4339
Phone (410) 879-9100
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 498841 | Other | MD | NCAS |
| 2238291 | Other | MD | AETNA HMO |
| 4669138 | Other | MD | AETNA PPO |
| 34735011 | Other | MD | BLUE SHIELD OF MD |
| 82012000 | Medicaid | MD | |
| E5130006 | Other | DC | BLUECHOICE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0020022 | MD | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104982651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "520 UPPER CHESAPEAKE DR",
"address_2": "SUITE 206",
"city": "BEL AIR",
"state": "MD",
"postal_code": "210144339",
"telephone_number": "410-879-9100",
"fax_number": "410-879-0227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 UPPER CHESAPEAKE DR",
"address_2": "SUITE 206",
"city": "BEL AIR",
"state": "MD",
"postal_code": "210144339",
"telephone_number": "410-879-9100",
"fax_number": "410-879-0227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROCTOR",
"first_name": "LEONARD",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "MD",
"license": "D0020022",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCAS",
"identifier": "498841",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "2238291",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO",
"identifier": "4669138",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF MD",
"identifier": "34735011",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "82012000",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECHOICE",
"identifier": "E5130006",
"state": "DC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bel Air, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.