Provider Demographics
NPI:1235123928
Name:LEIB, PAMELA LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LOUISE
Last Name:LEIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MAHANTONGO ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3009
Mailing Address - Country:US
Mailing Address - Phone:570-628-3554
Mailing Address - Fax:570-628-0194
Practice Address - Street 1:118 MAHANTONGO ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3009
Practice Address - Country:US
Practice Address - Phone:570-628-3554
Practice Address - Fax:570-628-0194
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-028473-E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A944323OtherVALUEOPTIONS
PA460243OtherHIGHMARK BLUE SHIELD
PA03211900OtherCAPITAL BLUE CROSS
PA1022890Medicaid
PALE460243Medicare ID - Type Unspecified
PA03211900OtherCAPITAL BLUE CROSS