Provider Demographics
NPI:1962454553
Name:WHEELER, LEIGH D (MD)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:D
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:2520 GREEN TECH DR
Practice Address - Street 2:STE D
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2300
Practice Address - Country:US
Practice Address - Phone:814-234-5021
Practice Address - Fax:814-235-3313
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD024032E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B41288Medicare UPIN
PA406624Medicare ID - Type Unspecified