Provider Demographics
NPI:1851824726
Name:LEDER, DOUGLAS CLARENCE (DO)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CLARENCE
Last Name:LEDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 S CENTRE AVE STE A3
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-8661
Mailing Address - Country:US
Mailing Address - Phone:610-921-6570
Mailing Address - Fax:610-926-8352
Practice Address - Street 1:5 S CENTRE AVE STE A3
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8661
Practice Address - Country:US
Practice Address - Phone:610-921-6570
Practice Address - Fax:610-926-8352
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS021306207QS0010X
GA85814207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine