Healthcare Provider Details

I. General information

NPI: 1235103631
Provider Name (Legal Business Name): MARGARET LEFFLER MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 E 1ST AVE
TARENTUM PA
15084-1831
US

IV. Provider business mailing address

317 E 1ST AVE
TARENTUM PA
15084-1831
US

V. Phone/Fax

Practice location:
  • Phone: 724-226-2900
  • Fax: 724-226-3435
Mailing address:
  • Phone: 724-226-2900
  • Fax: 724-226-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD422579
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100848280
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: