Organization
PACE & LEATHERWOOD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMY M BREITENBACH CMM (MEDICAL MANAGER)
(301) 645-6667
Entity
Organization
Contact information
Practice address
12070 OLD LINE CTR, SUITE 302, WALDORF, MD 20602-2513
(301) 645-6667
(301) 870-9722
Mailing address
PO BOX 249, WALDORF, MD 20604-0249
(301) 645-6667
(301) 870-9722
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371231100
—
MD
Enumeration date
03/10/2006
Last updated
04/10/2008
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