Provider Demographics
NPI:1295717221
Name:CLARKE, LEON E (MD)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:E
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:41 UNIVERSITY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1501 LANSDOWNE AVE STE 210
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1333
Practice Address - Country:US
Practice Address - Phone:610-534-6170
Practice Address - Fax:610-534-6159
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018475208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007978850003Medicaid
PA1542222OtherBLUE SHIELD
PA4597364OtherAETNA PPO
PA0052011000OtherKEYSTONE HEALTH PLAN EAST
PA30002018OtherKEYSTONE MERCY
PA3032802OtherAETNA HMO
PA3032802OtherAETNA HMO
PA086213R84Medicare UPIN