Provider Demographics
NPI:1568632974
Name:LECLERC, SUSAN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:LECLERC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:LECLERC
Other - Last Name:GERARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5456 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-8621
Mailing Address - Country:US
Mailing Address - Phone:717-361-8321
Mailing Address - Fax:
Practice Address - Street 1:5456 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-8621
Practice Address - Country:US
Practice Address - Phone:717-361-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028389E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine