Provider Demographics
NPI:1821380551
Name:DE LEON, JOSEPH A (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:DE LEON
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 1:10001 S EASTERN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3907
Mailing Address - Country:US
Mailing Address - Phone:702-616-5870
Mailing Address - Fax:702-616-5895
Practice Address - Street 1:300 E LANCASTER AVE
Practice Address - Street 2:SUITE 304 WYNNEWOOD HOUSE
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2139
Practice Address - Country:US
Practice Address - Phone:610-642-2002
Practice Address - Fax:610-642-7607
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443525207R00000X
NV15869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-2359401OtherMLHC TIN
PA23-2359401OtherMLHC TIN