Provider Demographics
NPI:1740263656
Name:GRABOYES-LEOPOLD, NANCY L (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:L
Last Name:GRABOYES-LEOPOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 JAMESTOWN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1751
Mailing Address - Country:US
Mailing Address - Phone:215-463-1483
Mailing Address - Fax:215-483-9185
Practice Address - Street 1:525 JAMESTOWN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1751
Practice Address - Country:US
Practice Address - Phone:215-463-1483
Practice Address - Fax:215-483-9185
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043194L207RG0100X
NJ25MA09810200207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4607503Medicaid
PA001244118Medicaid
PA671172EZPMedicare PIN
PA671172Medicare PIN
NJ4607503Medicaid
NJ473887TT5Medicare PIN
PA100009413Medicare PIN