Provider Demographics
NPI:1275528655
Name:BEIDLER, LEANNE K (MD)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:K
Last Name:BEIDLER
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 1:222 WILLOW VALLEY LAKES DR STE 400
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-9671
Mailing Address - Country:US
Mailing Address - Phone:717-544-8694
Mailing Address - Fax:717-544-8695
Practice Address - Street 1:222 WILLOW VALLEY LAKES DR STE 400
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9671
Practice Address - Country:US
Practice Address - Phone:717-544-8694
Practice Address - Fax:717-544-8695
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061485L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1114565OtherAETNA HMO
PA0016519100008Medicaid
PAP006207OtherGATEWAY HEALTH PLAN
PA001651910010Medicaid
PAG61167OtherHEALTH AMERICA
PAP006207OtherGEISINGER HEALTH PLAN
PA50038640OtherCAPITAL BLUE CROSS
PA5061535OtherAETNA NON-HMO
PA5061535OtherAETNA NON-HMO
PA1114565OtherAETNA HMO
PA0016519100008Medicaid