Provider Demographics
NPI:1528032752
Name:LEONG, PAUL LIWAH (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LIWAH
Last Name:LEONG
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 1:2643 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-5109
Mailing Address - Country:US
Mailing Address - Phone:412-621-3223
Mailing Address - Fax:412-381-3039
Practice Address - Street 1:2643 E CARSON ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-5109
Practice Address - Country:US
Practice Address - Phone:412-621-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426707174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101370546Medicaid
PA101370546Medicaid
PA092480EN4Medicare ID - Type Unspecified