Healthcare Provider Details

I. General information

NPI: 1215992201
Provider Name (Legal Business Name): LEON KRAYBILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 HARRISBURG PIKE SUITE 300
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

555 N DUKE ST
LANCASTER PA
17602-2250
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3022
  • Fax: 717-544-3021
Mailing address:
  • Phone: 717-544-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD037155E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: