Provider Demographics
NPI:1821486309
Name:FOPPERT, LEIGH RAPHAEL
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:RAPHAEL
Last Name:FOPPERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:STEPHANIE
Other - Last Name:RAPHAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:440 E MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5414
Mailing Address - Country:US
Mailing Address - Phone:610-436-1192
Mailing Address - Fax:
Practice Address - Street 1:440 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5414
Practice Address - Country:US
Practice Address - Phone:610-436-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014273363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics