Healthcare Provider Details

I. General information

NPI: 1477813780
Provider Name (Legal Business Name): LEAH GLEAVES STOCKTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5189
US

IV. Provider business mailing address

3401 N BROAD ST
PHILADELPHIA PA
19140-5189
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-3016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: