Provider Demographics
NPI:1588669105
Name:WARTLUFT, LEAH R (MD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:R
Last Name:WARTLUFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1130
Mailing Address - Country:US
Mailing Address - Phone:610-376-1981
Mailing Address - Fax:610-376-3153
Practice Address - Street 1:2630 WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1130
Practice Address - Country:US
Practice Address - Phone:610-376-1981
Practice Address - Fax:610-376-3153
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421628207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019505160002Medicaid
PA0019505160002Medicaid
069221Medicare ID - Type Unspecified