Provider Demographics
NPI:1578531653
Name:TUPCHONG, LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:TUPCHONG
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:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-0537
Mailing Address - Country:US
Mailing Address - Phone:610-278-2510
Mailing Address - Fax:610-278-2509
Practice Address - Street 1:2701 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1820
Practice Address - Country:US
Practice Address - Phone:610-278-2510
Practice Address - Fax:610-278-2509
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033078E2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009921910002Medicaid
PA0009921910002Medicaid
B33480Medicare UPIN