Provider Demographics
NPI:1558386342
Name:LEONARD HALTRECHT
Entity Type:Organization
Organization Name:LEONARD HALTRECHT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-353-5840
Mailing Address - Street 1:1999 SPROUL RD
Mailing Address - Street 2:STE 21
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3508
Mailing Address - Country:US
Mailing Address - Phone:610-353-5840
Mailing Address - Fax:
Practice Address - Street 1:1999 SPROUL RD
Practice Address - Street 2:STE 21
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3508
Practice Address - Country:US
Practice Address - Phone:610-353-5840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002378L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA041839OtherBLUE SHIELD
PA232187546OtherCIGNA
PA0007336180001Medicaid
PA6548OtherAETNA
PA015630208OtherRAILROAD MEDICARE
PA0032051001OtherKEYSTONE
PA6548OtherAETNA
PA0007336180001Medicaid
PA=========OtherTRICARE
PA6548OtherAETNA