Individual
DR. MARTIN LEICHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9331 OLD BUSTLETON AVE, SUITE 100, PHILADELPHIA, PA 19115-4634
(215) 671-0653
(215) 671-0970
Mailing address
PO BOX 820933, PHILADELPHIA, PA 19182-0933
(215) 926-9010
(215) 226-8285
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
MD024528E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000777434
—
PA
01
—
597586
MEDICARE GROUP
PA
Enumeration date
04/13/2006
Last updated
07/20/2011
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