Active NPI
Leonardo Leonor Leonidas, MD
- Pediatrics Physician
- Bangor, ME
National Provider Identifier
1710915111
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 007119
- Practice address
- 700 Mt Hope Ave
Ste 640
Bangor, ME 04401 - Phone
- (207) 947-6739
- Fax
- (207) 942-3554
- NPI assigned
- Jun 28, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 007119 | ME | Primary |
Addresses
Primary practice location
700 Mt Hope Ave
Ste 640
Bangor, ME 04401
Mailing address
700 Mt Hope Ave
Ste 640
Bangor, ME 04401
Phone (207) 947-6739
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1042254 | Other | ME | AETNA |
| M7640C | Other | ME | CIGNA |
| 000037M | Other | ME | ANTHEM |
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 |
|---|---|---|---|
| 007119 | ME | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primary Care Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Exclusive Provider Organization
- Bangor, ME
- NPI 1548306723
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710915111",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 MT HOPE AVE",
"address_2": "STE 640",
"city": "BANGOR",
"state": "ME",
"postal_code": "04401",
"telephone_number": "207-947-6739",
"fax_number": "207-942-3554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 MT HOPE AVE",
"address_2": "STE 640",
"city": "BANGOR",
"state": "ME",
"postal_code": "04401",
"telephone_number": "207-947-6739",
"fax_number": "207-942-3554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEONIDAS",
"first_name": "LEONARDO",
"middle_name": "LEONOR",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "ME",
"license": "007119",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "1042254",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "M7640C",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000037M",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
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.