Provider Demographics
NPI:1467461707
Name:LEONARDI, MARINO (MD)
Entity Type:Individual
Prefix:
First Name:MARINO
Middle Name:
Last Name:LEONARDI
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 1:2705 DEKALB PIKE
Mailing Address - Street 2:MSH SUITE 202
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1852
Mailing Address - Country:US
Mailing Address - Phone:610-292-6520
Mailing Address - Fax:610-292-7126
Practice Address - Street 1:2705 DEKALB PIKE
Practice Address - Street 2:MSH SUITE 202
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1852
Practice Address - Country:US
Practice Address - Phone:610-292-6520
Practice Address - Fax:610-292-7126
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437059207RC0001X, 207R00000X, 207RC0000X, 207RC0001X
NY271668-1207R00000X, 207RC0000X, 207RC0001X
ARE-4095207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5M964OtherBCBS
PA200321130AMedicaid
P00146214OtherRAILROAD MEDICARE1
AR154787001Medicaid
04080015600OtherQUALCHOICE
5M964Medicare PIN
I10370Medicare UPIN