Provider Demographics
NPI:1528098910
Name:LEVENTHAL, EDWARD K (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:K
Last Name:LEVENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:250 FAME AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1587
Mailing Address - Country:US
Mailing Address - Phone:717-646-7011
Mailing Address - Fax:717-646-7437
Practice Address - Street 1:250 FAME AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1587
Practice Address - Country:US
Practice Address - Phone:717-646-7011
Practice Address - Fax:717-646-7437
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD38789208800000X
PAMD048429L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD786602000Medicaid
PA1029028840001Medicaid
PA1029028840001Medicaid
PA341761ZEA5Medicare PIN