Provider Demographics
NPI:1659477057
Name:LEONIDA, EFREN L (MD)
Entity Type:Individual
Prefix:DR
First Name:EFREN
Middle Name:L
Last Name:LEONIDA
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:ONE BRADDOCK AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666
Mailing Address - Country:US
Mailing Address - Phone:724-547-4565
Mailing Address - Fax:724-547-5811
Practice Address - Street 1:ONE BRADDOCK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666
Practice Address - Country:US
Practice Address - Phone:724-547-4565
Practice Address - Fax:724-547-5811
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA034778L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005893540003Medicaid
PA0360813OtherUMWA
PA474504OtherAETNA
PA60472OtherUNISON HEALTH PLAN
PA094320OtherHIGHMARK
PA1004398OtherGATEWAY HEALTH PLAN
PA0094320OtherKEYSTONE HEALTH PLAN WEST
PALE94320Medicare ID - Type Unspecified
PA0360813OtherUMWA
PAP00153686Medicare ID - Type UnspecifiedRAILROAD MEDICARE