Provider Demographics
NPI:1730453440
Name:EFREN LEONIDA MD LLC
Entity type:Organization
Organization Name:EFREN LEONIDA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:K
Authorized Official - Last Name:VINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-547-4565
Mailing Address - Street 1:1 BRADDOCK ROAD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1458
Mailing Address - Country:US
Mailing Address - Phone:724-547-4565
Mailing Address - Fax:
Practice Address - Street 1:1 BRADDOCK ROAD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1458
Practice Address - Country:US
Practice Address - Phone:724-547-4565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034778L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty