Healthcare Provider Details

I. General information

NPI: 1629071428
Provider Name (Legal Business Name): ALFRED R LEAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ERFORD RD SUITE 101
CAMP HILL PA
17011-1802
US

IV. Provider business mailing address

101 ERFORD RD SUITE 101
CAMP HILL PA
17011-1802
US

V. Phone/Fax

Practice location:
  • Phone: 717-975-8900
  • Fax: 717-975-9400
Mailing address:
  • Phone: 717-975-8900
  • Fax: 717-975-9400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD042102L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: