Provider Demographics
NPI:1184863953
Name:LECLERC, JACQUES ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:ROBERT
Last Name:LECLERC
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 1:600 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1218
Mailing Address - Country:US
Mailing Address - Phone:717-216-2038
Mailing Address - Fax:717-216-2082
Practice Address - Street 1:600 N 12TH ST
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1218
Practice Address - Country:US
Practice Address - Phone:717-216-2038
Practice Address - Fax:717-216-2082
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD459858207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA403373YJBAMedicare PIN