Provider Demographics
NPI:1619013505
Name:GARY A LEASE
Entity Type:Organization
Organization Name:GARY A LEASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LEASE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-764-3373
Mailing Address - Street 1:510 GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-1335
Mailing Address - Country:US
Mailing Address - Phone:717-764-0375
Mailing Address - Fax:
Practice Address - Street 1:510 GREENBRIAR RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-1335
Practice Address - Country:US
Practice Address - Phone:717-764-0375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003383L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA157356Medicare UPIN
PA073270Medicare UPIN
PAQ02978Medicare UPIN
PAD98735Medicare UPIN