Individual
CRYSTAL IVAHNA LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
17351 MELFORD BLVD, BOWIE, MD 20715-4457
(240) 548-1300
(240) 548-1695
Mailing address
14640 GOVERNOR SPRIGG PL, UPPER MARLBORO, MD 20772-5910
(504) 915-3461
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
95216
GA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
D0085741
MD
208100000X
Physical Medicine & Rehabilitation Physician
M-17056
ID
208100000X
Physical Medicine & Rehabilitation Physician
MD046990
DC
Other
Enumeration date
04/16/2014
Last updated
05/24/2023
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