Healthcare Provider Details

I. General information

NPI: 1952531766
Provider Name (Legal Business Name): LEILA STUART MARTIN BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7517 NEWLAND ST
PHILADELPHIA PA
19128
US

IV. Provider business mailing address

7517 NEWLAND ST
PHILADELPHIA PA
19128-4134
US

V. Phone/Fax

Practice location:
  • Phone: 215-482-2352
  • Fax:
Mailing address:
  • Phone: 215-482-2352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberF03232
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: