MEDICARE: DR. MARTIN LEICHT MD

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD024528E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	597586	OTHER	PA	MEDICARE GROUP

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	:	1841254323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN LEICHT MD

Provider Business Mailing Address
First Line	:	PO BOX 820933
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-0933
Country	:	US
Telephone Number	:	215-926-9010
Fax Number	:	215-226-8285

Provider Business Practice Location Address
First Line	:	9331 OLD BUSTLETON AVE
Second Line	:	SUITE 100
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-4634
Country	:	US
Telephone Number	:	215-671-0653
Fax Number	:	215-671-0970

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	07/20/2011

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Directions to “ DR. MARTIN LEICHT MD” Practice Location

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