Provider Demographics
NPI:1083661185
Name:LEBOVITZ, SHELDON (DO)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:
Last Name:LEBOVITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 PHOENIX DR STE A
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4534
Mailing Address - Country:US
Mailing Address - Phone:717-264-6185
Mailing Address - Fax:717-264-8226
Practice Address - Street 1:435 PHOENIX DR STE A
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4534
Practice Address - Country:US
Practice Address - Phone:717-264-6185
Practice Address - Fax:717-264-8226
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003505L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000729329OtherHIGHMARK BLUE SHIELD ID
PA000596751Medicaid
PA0571608001OtherHMO BLUE CROSS ID
PA2083OtherAETNA ID
PA2083OtherAETNA ID
PA000729329OtherHIGHMARK BLUE SHIELD ID
DE408235ZNZ3Medicare PIN
PA94581Medicare PIN