Provider Demographics
NPI:1225072192
Name:LEICHNER, JOHN P (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:LEICHNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:P
Other - Last Name:LEICHNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10900 KNIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-4210
Mailing Address - Country:US
Mailing Address - Phone:215-632-0693
Mailing Address - Fax:215-637-1681
Practice Address - Street 1:10900 KNIGHTS RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-4210
Practice Address - Country:US
Practice Address - Phone:215-632-0693
Practice Address - Fax:215-637-1681
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023910E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007187560005Medicaid
PA159865Medicare PIN
PA159865LGWMedicare PIN
C32302Medicare UPIN