Provider Demographics
NPI:1265429468
Name:WISOTSKY, LEONARD (DPM)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:WISOTSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6188 OXON HILL RD
Mailing Address - Street 2:STE 804
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3113
Mailing Address - Country:US
Mailing Address - Phone:301-567-5005
Mailing Address - Fax:301-839-5677
Practice Address - Street 1:6188 OXON HILL RD
Practice Address - Street 2:STE 804
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3113
Practice Address - Country:US
Practice Address - Phone:301-567-5005
Practice Address - Fax:301-839-5677
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD0422213E00000X
DC290213E00000X
VA373213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
08378OtherAMERIGROUP/AMERICAID
4718680001OtherDMERC
7531019OtherAETNA
2130326OtherMAMSI
521093122OtherFIRST HEALTH
80850001OtherBLUE CROSS BLUE SHIELD NC
036217OtherANTHEM BCBS OF VA
521093122OtherPRUDENTIAL
MD36911001OtherBLUE CROSS BLUE SHIELD
7020305POtherCIGNA PPO
80850001OtherBLUE CROSS BLUE SHIELD FE
521093122OtherGEHA
MD602548000Medicaid
81581OtherNATIONAL CAPITAL PPO
27496OtherPRIORITY PARTNERS
493157OtherHEALTHLINK NCPPO
521093122OtherMAILHANDLERS
80850001OtherBLUE CHOICE
036217OtherANTHEM BCBS OF VA
2130326OtherMAMSI