Provider Demographics
NPI:1093733289
Name:LEBER, DAVID CLAIR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CLAIR
Last Name:LEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1222
Mailing Address - Country:US
Mailing Address - Phone:717-233-4691
Mailing Address - Fax:717-233-8836
Practice Address - Street 1:2807 N FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1222
Practice Address - Country:US
Practice Address - Phone:717-233-4691
Practice Address - Fax:717-233-8836
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-012624-E208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00074076001Medicaid
PAB35144Medicare UPIN
PA00074076001Medicaid