Provider Demographics
NPI:1184645509
Name:EWING, LEONA (DO)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:
Last Name:EWING
Suffix:
Gender:F
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:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-0300
Mailing Address - Country:US
Mailing Address - Phone:717-270-7780
Mailing Address - Fax:717-274-9746
Practice Address - Street 1:850 TUCK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7477
Practice Address - Country:US
Practice Address - Phone:717-273-5803
Practice Address - Fax:717-272-8422
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003439L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA143362OtherHIGHMARK
PA0006286030002Medicaid
PA143362OtherHIGHMARK
PAE63636Medicare UPIN