Provider Demographics
NPI:1316998545
Name:LESCHEK-GELMAN, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LESCHEK-GELMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E OLNEY AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2470
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:1151 OLD YORK RD STE 200
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3816
Practice Address - Country:US
Practice Address - Phone:215-957-9250
Practice Address - Fax:215-957-9254
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061589L2084N0400X, 2084N0600X, 2084S0012X
DEC1-00054052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE918101Medicaid
G76799Medicare UPIN
1519N22Medicare ID - Type Unspecified