Provider Demographics
NPI:1629071428
Name:LEAL, ALFRED R (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:R
Last Name:LEAL
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 1:101 ERFORD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1802
Mailing Address - Country:US
Mailing Address - Phone:717-975-8900
Mailing Address - Fax:717-975-9400
Practice Address - Street 1:101 ERFORD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1802
Practice Address - Country:US
Practice Address - Phone:717-975-8900
Practice Address - Fax:717-975-9400
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042102L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50026516OtherCAPITAL BLUE CROSS
PA78230OtherHIGHMARK BLUE SHIELD
PA078230Medicare ID - Type UnspecifiedINDIVIDUAL #
PA50026516OtherCAPITAL BLUE CROSS