Provider Demographics
NPI:1700374949
Name:LEID, ADAM (DO)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:LEID
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 NATHAN DR
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-1584
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CORE CLINIC
Practice Address - Street 2:459 SPROUL RD
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085
Practice Address - Country:US
Practice Address - Phone:717-719-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS022500208D00000X
PAOSO22500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice