Individual
LEO I STEMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 STAFFORD ST, SUITE 300, SPRINGFIELD, MA 01104-3581
(413) 748-9860
Mailing address
157 NEWGATE RD, EAST GRANBY, CT 06026-9545
(413) 537-7526
(530) 239-3025
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
78458
MA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
78458
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3142400
—
MA
Enumeration date
04/06/2006
Last updated
01/10/2008
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