Provider Demographics
NPI:1770617193
Name:LEOPOLD, GRETTA (MD)
Entity type:Individual
Prefix:DR
First Name:GRETTA
Middle Name:
Last Name:LEOPOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3036
Mailing Address - Country:US
Mailing Address - Phone:215-972-0617
Mailing Address - Fax:
Practice Address - Street 1:2400 CHESTNUT ST
Practice Address - Street 2:#2307
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4316
Practice Address - Country:US
Practice Address - Phone:215-972-0617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021597E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry