Provider Demographics
NPI:1902809791
Name:FLEISCHER, LEROY (MD)
Entity type:Individual
Prefix:DR
First Name:LEROY
Middle Name:
Last Name:FLEISCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W CHESTER PIKE STE 201
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4530
Mailing Address - Country:US
Mailing Address - Phone:610-853-2900
Mailing Address - Fax:610-853-2980
Practice Address - Street 1:301 W CHESTER PIKE STE 201
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4530
Practice Address - Country:US
Practice Address - Phone:610-853-2900
Practice Address - Fax:610-853-2980
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2022-02-28
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-07-26
Provider Licenses
StateLicense IDTaxonomies
PAMD038294E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA173695OtherBLUE SHIELD
PA2038508001OtherKEYSTONE
PA010552488OtherUNITED HEALTHCARE
PA010552488OtherTRICARE
PA010552488OtherCIGNA
PA138042OtherAETNA
PA0011091310001Medicaid
PA080192391OtherTRAVELERS MEDICARE
PA138042OtherAETNA
PAE98012Medicare UPIN