Provider Demographics
NPI:1114367794
Name:ELMORE, LEISHA CAROL (MD)
Entity type:Individual
Prefix:DR
First Name:LEISHA
Middle Name:CAROL
Last Name:ELMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3737 MARKET ST FL 4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5544
Mailing Address - Country:US
Mailing Address - Phone:215-294-9430
Mailing Address - Fax:215-222-5733
Practice Address - Street 1:3737 MARKET ST FL 4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5544
Practice Address - Country:US
Practice Address - Phone:215-294-9430
Practice Address - Fax:215-222-5733
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2021-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD474719208600000X
TXS6172208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery