Provider Demographics
NPI:1134142318
Name:ROSENFELD, LEONARD E (DO)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:E
Last Name:ROSENFELD
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 1:1740 SOUTH ST STE 402
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1514
Mailing Address - Country:US
Mailing Address - Phone:215-382-6112
Mailing Address - Fax:215-382-6115
Practice Address - Street 1:1740 SOUTH ST STE 402
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1514
Practice Address - Country:US
Practice Address - Phone:215-382-6112
Practice Address - Fax:215-382-6115
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05001780L207R00000X
PA0S001780L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006901360002Medicaid
D66314Medicare UPIN
PA041543D86Medicare ID - Type Unspecified