Healthcare Provider Details

I. General information

NPI: 1063868958
Provider Name (Legal Business Name): LEAH MICHELLE ARLEQUIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEAH MICHELLE MILLER MD

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COMMUNITY DR
TOBYHANNA PA
18466
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 570-895-2300
  • Fax: 570-895-4270
Mailing address:
  • Phone: 484-884-4500
  • Fax: 484-884-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD468982
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT212216
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: