Provider Demographics
NPI:1609830520
Name:LEBED, JOEL P (DO)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:P
Last Name:LEBED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OLD YORK RD
Mailing Address - Street 2:SUITE 3-108
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3606
Mailing Address - Country:US
Mailing Address - Phone:215-885-5600
Mailing Address - Fax:215-885-1721
Practice Address - Street 1:100 OLD YORK RD
Practice Address - Street 2:SUITE 3-108
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3606
Practice Address - Country:US
Practice Address - Phone:215-885-5600
Practice Address - Fax:215-885-1721
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS003518L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2103OtherAETNA USHC
PA0045364000OtherBLUE SHIELD
PA2103OtherAETNA USHC
PAB34769Medicare UPIN