Provider Demographics
NPI:1104001577
Name:COALMER, LEAH CORRINE (PA-C)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:CORRINE
Last Name:COALMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:CORRINE
Other - Last Name:HEFFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1307 FEDERAL ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4769
Mailing Address - Country:US
Mailing Address - Phone:412-281-1757
Mailing Address - Fax:412-281-7274
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:412-281-1757
Practice Address - Fax:412-281-7274
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053745363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
13839740OtherCAQH
PA103207081Medicaid