Provider Demographics
NPI:1093210361
Name:CORNACCHIO, LEIGHANN MICHELLE
Entity Type:Individual
Prefix:
First Name:LEIGHANN
Middle Name:MICHELLE
Last Name:CORNACCHIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 E MOORESTOWN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:WIND GAP
Mailing Address - State:PA
Mailing Address - Zip Code:18091-9683
Mailing Address - Country:US
Mailing Address - Phone:484-526-7740
Mailing Address - Fax:
Practice Address - Street 1:487 E MOORESTOWN RD STE 105
Practice Address - Street 2:
Practice Address - City:WIND GAP
Practice Address - State:PA
Practice Address - Zip Code:18091-9683
Practice Address - Country:US
Practice Address - Phone:484-526-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS022187208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics