Provider Demographics
NPI:1003829508
Name:MAYRO, LESLIE BARBARA (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:BARBARA
Last Name:MAYRO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:500 S BROAD ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1613
Mailing Address - Country:US
Mailing Address - Phone:215-685-6769
Mailing Address - Fax:215-685-6732
Practice Address - Street 1:2230 COTTMAN AVE
Practice Address - Street 2:HEALTH CARE CENTER #10
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1230
Practice Address - Country:US
Practice Address - Phone:215-685-0639
Practice Address - Fax:215-725-4877
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2015-02-12
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Provider Licenses
StateLicense IDTaxonomies
PAMD032149E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011336100008Medicaid
PA209690EVHMedicare PIN
PAC33800Medicare UPIN