Provider Demographics
NPI:1235105115
Name:LEEDY, W ROWLAND (DO)
Entity Type:Individual
Prefix:
First Name:W
Middle Name:ROWLAND
Last Name:LEEDY
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 1:538 FAIRVIEW TER
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3608
Mailing Address - Country:US
Mailing Address - Phone:717-843-5012
Mailing Address - Fax:
Practice Address - Street 1:1777 5TH AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2632
Practice Address - Country:US
Practice Address - Phone:717-843-8051
Practice Address - Fax:717-846-0821
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002257L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000759632Medicaid
PAD66268Medicare UPIN
PA000759632Medicaid