Most Relevant Information
Provider Data
| NPI Number: | 1003400094 |
| Provider Name: | BRIAN MICHAEL BOSTON LE |
| Entity Type: | Individual |
| Taxonomy Code: | 174400000X |
| Specialty: | Specialist |
| License Number: | E01474 |
Most Important Dates
| Enumeration Date: | 02/22/2021 |
| Last Updated: | 02/22/2021 |
Provider Practice Location
1621 SULGRAVE AVE
BALTIMORE
MD
212093664
Practice Location Phone/Fax
| Phone: | 4105780033 |
| Fax: |
Provider Mailing Location
707 YORK RD APT 5209
TOWSON
MD
212042892
Provider Mailing Phone/Fax
| Phone: | 4103652798 |
| Fax: |