MEDICARE: MARA LEYZIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0000X	Adolescent Medicine (Family Medicine) Physician	MD032043E	PA
2	207Q00000X	Family Medicine Physician	MD032043E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003992579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARA LEYZIN M.D.

Provider Business Mailing Address
First Line	:	8025 CASTOR AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2733
Country	:	US
Telephone Number	:	215-745-9900
Fax Number	:	215-745-9902

Provider Business Practice Location Address
First Line	:	8025 CASTOR AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2733
Country	:	US
Telephone Number	:	215-745-9900
Fax Number	:	215-745-9902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	12/11/2012

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