MEDICARE: JENNIFER ELIZABETH LEAP D.O.

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	390200000X	Student in an Organized Health Care Education/Training Program		PA
2	207RP1001X	Pulmonary Disease Physician	OS018590	PA

General Provider Information

NPI Number	:	1649680828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ELIZABETH LEAP D.O.

Provider Business Mailing Address
First Line	:	1200 BROOKS LN STE 180
Second Line	:
City	:	CLAIRTON
State	:	PA
Zip	:	15025-3769
Country	:	US
Telephone Number	:	412-469-3600
Fax Number	:	412-469-3630

Provider Business Practice Location Address
First Line	:	1200 BROOKS LN STE 180
Second Line	:
City	:	JEFFERSON HILLS
State	:	PA
Zip	:	15025-3769
Country	:	US
Telephone Number	:	412-729-1500
Fax Number	:	412-384-2462

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

Provider Enumeration Date	:	04/28/2014
Last Update Date	:	11/17/2023

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