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General NPI Number Information
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NPI Number | 1346271418
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Entity Type | Organization
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Legal Business Name | LEBER & BANDUCCI PLASTIC SURGERY LTD
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 10/12/2010
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Provider Practice Location Address
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Address Line | 2807 N FRONT ST
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City | HARRISBURG
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State | PA
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Zip | 17110-1222
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Country | US
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Telephone | 717-233-4691
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Fax | 717-233-8836
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Provider Business Mailing Address
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Address Line | 2807 N FRONT ST
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City | HARRISBURG
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State | PA
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Zip | 17110-1222
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Country | US
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Telephone | 717-233-4691
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Fax | 717-233-8836
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | MR. JOHN DALE DEITER
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Credential | MD
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Telephone | 717-233-4691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | MD-012624-E
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License Number State | PA
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