Provider Demographics
NPI:1225040991
Name:CLAROS, LEONARDO (MD)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:CLAROS
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 1:240 CETRONIA RD
Mailing Address - Street 2:SUITE 205N
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9263
Mailing Address - Country:US
Mailing Address - Phone:484-426-2600
Mailing Address - Fax:610-336-4379
Practice Address - Street 1:240 CETRONIA RD
Practice Address - Street 2:SUITE 205N
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9263
Practice Address - Country:US
Practice Address - Phone:484-426-2600
Practice Address - Fax:610-336-4379
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200045174400000X
PAMD437674208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA158400Medicare PIN