Provider Demographics
NPI:1114955606
Name:BEKERIS, LEONAS G (MD)
Entity Type:Individual
Prefix:
First Name:LEONAS
Middle Name:G
Last Name:BEKERIS
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 1:140 NUTT ROAD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3906
Mailing Address - Country:US
Mailing Address - Phone:610-983-1167
Mailing Address - Fax:610-983-1612
Practice Address - Street 1:140 NUTT ROAD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-3906
Practice Address - Country:US
Practice Address - Phone:610-983-1167
Practice Address - Fax:610-983-1612
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD06033L207ZP0102X
PAMD060633L207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016288220001Medicaid
PA0016288220001Medicaid
C44633Medicare UPIN