Provider Demographics
NPI:1578586566
Name:LEONARD, CRAIG PAUL (MSPT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:PAUL
Last Name:LEONARD
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 WILLOW POND DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5793
Mailing Address - Country:US
Mailing Address - Phone:215-676-4070
Mailing Address - Fax:
Practice Address - Street 1:2869 HOLME AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2118
Practice Address - Country:US
Practice Address - Phone:215-676-4070
Practice Address - Fax:215-676-4071
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008976L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2004000000OtherKEYSTONE HEALTH PLAN EAST
PAPA BLUE SHIELDOther1311180
PA045559PRLOtherMEDICARE ID
PA2004000000OtherAMERIHEALTH
PA2563889OtherAETNA/ US HEALTH CARE