Provider Demographics
NPI:1003068057
Name:LEROY B. FLEISCHER, M.D., P.C.
Entity Type:Organization
Organization Name:LEROY B. FLEISCHER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:B
Authorized Official - Last Name:FLEISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-353-5840
Mailing Address - Street 1:1999 SPROUL RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3508
Mailing Address - Country:US
Mailing Address - Phone:610-353-5840
Mailing Address - Fax:610-353-3420
Practice Address - Street 1:1999 SPROUL RD
Practice Address - Street 2:SUITE 21
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3508
Practice Address - Country:US
Practice Address - Phone:610-353-5840
Practice Address - Fax:610-353-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038294E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA010552488OtherCIGNA
PA138042OtherAETNA
PA0011091310001Medicaid
PA010552488OtherTRICARE
PA080192391OtherTRAVELERS MEDICARE
PA173695OtherBLUE SHIELD
PA2038508001OtherKEYSTONE
PA010552488OtherUNITED HEALTHCARE
PA080192391OtherTRAVELERS MEDICARE
PA0011091310001Medicaid