Provider Demographics
NPI:1134222185
Name:JAROS, LESLIE K (PA-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:K
Last Name:JAROS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 TUNNEL RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3875
Mailing Address - Country:US
Mailing Address - Phone:570-622-5455
Mailing Address - Fax:570-622-5493
Practice Address - Street 1:2866 W PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:OLEY
Practice Address - State:PA
Practice Address - Zip Code:19547-8922
Practice Address - Country:US
Practice Address - Phone:610-987-3451
Practice Address - Fax:610-987-6809
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052108363A00000X
PAOA000289L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
50058171OtherCAPITAL BLUE
PA200707JPUMedicare PIN
50058171OtherCAPITAL BLUE