Provider Demographics
NPI:1962519595
Name:LEIBOVIC, STEPHEN JACOB (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JACOB
Last Name:LEIBOVIC
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:PO BOX 780125
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0125
Mailing Address - Country:US
Mailing Address - Phone:804-922-4844
Mailing Address - Fax:
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-4425
Practice Address - Country:US
Practice Address - Phone:804-828-3060
Practice Address - Fax:804-828-3045
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA541749837207XS0106X, 207XS0114X, 207XX0004X, 207XX0801X, 2082S0105X, 2086S0105X
VA01010457932082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA028179OtherHAND SURGERY
VA3009495OtherHAND SURGERY
VA541749837OtherHAND SURGERY
VA321434OtherHAND SURGERY
VAE53302Medicare UPIN
VA028179OtherHAND SURGERY