Provider Demographics
NPI:1316230881
Name:TATIANA LEIBU, M.D., PC
Entity Type:Organization
Organization Name:TATIANA LEIBU, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIBU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-837-9066
Mailing Address - Street 1:660 PELLIS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4633
Mailing Address - Country:US
Mailing Address - Phone:724-837-9066
Mailing Address - Fax:724-837-9231
Practice Address - Street 1:660 PELLIS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4633
Practice Address - Country:US
Practice Address - Phone:724-837-9066
Practice Address - Fax:724-837-9231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058891L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG37841Medicare UPIN