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General NPI Number Information
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NPI Number | 1831534445
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Entity Type | Individual
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Provider Name | AMY LEIB
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Gender | Female
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Dates
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Enumeration Date | 05/09/2013
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 4 INDUSTRIAL BLVD STE 200
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City | PAOLI
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State | PA
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Zip | 19301-1605
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Country | US
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Telephone | 610-647-4161
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Fax |
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Provider Business Mailing Address
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Address Line | 176 S NEW MIDDLETOWN RD STE 203
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City | MEDIA
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State | PA
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Zip | 19063-5255
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Country | US
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Telephone | 610-566-7300
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | MT203560
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 0116026680
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD460475
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License Number State | PA
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