Healthcare Provider Details

I. General information

NPI: 1174521165
Provider Name (Legal Business Name): LAWRENCE J LEVENTHAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 03/29/2021
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 WELSH RD SUITE 201
HUNTINGDON VALLEY PA
19006-6310
US

IV. Provider business mailing address

727 WELSH RD SUITE 201
HUNTINGDON VALLEY PA
19006-6310
US

V. Phone/Fax

Practice location:
  • Phone: 215-947-8701
  • Fax: 215-947-9704
Mailing address:
  • Phone: 215-947-8701
  • Fax: 215-947-9704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD034222E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: