Provider Demographics
NPI:1629181797
Name:LEATHERS, DONALD JOEL (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JOEL
Last Name:LEATHERS
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 1:224 PENN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2154
Mailing Address - Country:US
Mailing Address - Phone:412-247-4500
Mailing Address - Fax:412-247-4550
Practice Address - Street 1:777 RURAL AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3109
Practice Address - Country:US
Practice Address - Phone:570-321-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030006E207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA475269OtherHIGHMARK/BLUE SHIELD
PA809443OtherFIRST PRIORITY/HMO OF NE
PA0011421630002Medicaid
PA475269OtherHIGHMARK/BLUE SHIELD
475269Medicare ID - Type Unspecified