Healthcare Provider Details

I. General information

NPI: 1124170394
Provider Name (Legal Business Name): RICHARD A LEBOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E UNIVERSITY PKWY
BALTIMORE MD
21218-2828
US

IV. Provider business mailing address

1000 RIVER RD STE 100
CONSHOHOCKEN PA
19428-2439
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-2000
  • Fax:
Mailing address:
  • Phone: 800-355-3818
  • Fax: 610-834-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0024026
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: