MEDICARE: LEONARD CHESTER BANDALA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD-043625-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588668560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD CHESTER BANDALA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 62219-2219
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-0001
Country	:	US
Telephone Number	:	201-804-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S 9TH ST
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-1812
Country	:	US
Telephone Number	:	610-379-0443
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	08/04/2008

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