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General NPI Number Information
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NPI Number | 1801816681
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Entity Type | Individual
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Provider Name | THOMAS P. LEIST M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 05/16/2014
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Provider Practice Location Address
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Address Line | 900 WALNUT ST 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5509
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Country | US
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Telephone | 215-955-6871
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Fax | 215-503-2990
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Provider Business Mailing Address
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Address Line | 900 WALNUT ST 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5509
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Country | US
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Telephone | 215-955-6871
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Fax | 215-503-2990
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD-070815-L
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License Number State | PA
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