Healthcare Provider Details

I. General information

NPI: 1902809791
Provider Name (Legal Business Name): LEROY FLEISCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date: 03/17/2006
Reactivation Date: 07/26/2006

III. Provider practice location address

301 W CHESTER PIKE STE 201
HAVERTOWN PA
19083-4530
US

IV. Provider business mailing address

301 W CHESTER PIKE STE 201
HAVERTOWN PA
19083-4530
US

V. Phone/Fax

Practice location:
  • Phone: 610-853-2900
  • Fax: 610-853-2980
Mailing address:
  • Phone: 610-853-2900
  • Fax: 610-853-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD038294E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: