| Pace & Leatherwood, Pc | |
|
12070 Old Line Ctr Suite 302 Waldorf MD 20602-2513 | |
| (301) 645-6667 | |
| (301) 870-9722 |
| Full Name | Pace & Leatherwood, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 12070 Old Line Ctr, Waldorf, Maryland |
| Authorized Official Name and Position | Tammy M Breitenbach (MEDICAL MANAGER) |
| Authorized Official Contact | 3016456667 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pace & Leatherwood, Pc Po Box 249 Waldorf MD 20604-0249 Ph: (301) 645-6667 | Pace & Leatherwood, Pc 12070 Old Line Ctr Suite 302 Waldorf MD 20602-2513 Ph: (301) 645-6667 |
| NPI Number | 1912975277 |
|---|---|
| Provider Enumeration Date | 03/10/2006 |
| Last Update Date | 04/10/2008 |
| Medicare PECOS PAC ID | 6901883776 |
|---|---|
| Medicare Enrollment ID | O20040630000873 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912975277 | NPI | - | NPPES |
| 371231100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| Provider Name | Michael Leatherwood |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497747349 PECOS PAC ID: 9032196662 Enrollment ID: I20100921001418 |
| Provider Name | Robert Timothy Pace |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326030040 PECOS PAC ID: 2668598095 Enrollment ID: I20100923000158 |
| Provider Name | Denise L Colton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427494343 PECOS PAC ID: 7012158207 Enrollment ID: I20130731000321 |
| Provider Name | Georgia Cu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629127824 PECOS PAC ID: 6305885237 Enrollment ID: I20140327001173 |
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