Provider Demographics
NPI:1497789051
Name:PALLONE, LESLIE T (DO)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:T
Last Name:PALLONE
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 1:246 FRIENDSHIP CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009
Mailing Address - Country:US
Mailing Address - Phone:724-773-5207
Mailing Address - Fax:724-774-7476
Practice Address - Street 1:246 FRIENDSHIP CIRCLE
Practice Address - Street 2:FRIENDSHIP RIDGE
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009
Practice Address - Country:US
Practice Address - Phone:724-773-5207
Practice Address - Fax:724-774-7476
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002389L207Q00000X
MO30646207Q00000X
OH34001702P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009911110006Medicaid
PA0009911110006Medicaid
B34215Medicare UPIN