Provider Demographics
NPI:1568450526
Name:LEECH, STEPHEN H (MB CHB PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:H
Last Name:LEECH
Suffix:
Gender:M
Credentials:MB CHB PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 827783
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19185-7783
Mailing Address - Country:US
Mailing Address - Phone:215-707-4353
Mailing Address - Fax:215-707-2781
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-4353
Practice Address - Fax:215-707-2781
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 051231L207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014694770001Medicaid
B64710Medicare UPIN
PA0014694770001Medicaid