Provider Demographics
NPI:1043202161
Name:FORERO, LEONOR (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONOR
Middle Name:
Last Name:FORERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEONOR
Other - Middle Name:
Other - Last Name:FORERO-BRIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2925 WILLIAM PENN HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5283
Mailing Address - Country:US
Mailing Address - Phone:610-258-1400
Mailing Address - Fax:610-258-3047
Practice Address - Street 1:2925 WILLIAM PENN HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5283
Practice Address - Country:US
Practice Address - Phone:610-258-1400
Practice Address - Fax:610-258-3047
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019240510003Medicaid
PA1423978OtherHIGHMARK PIN
063933QODMedicare PIN
PA1423978OtherHIGHMARK PIN
E81632Medicare UPIN