Basic Information
Provider Information
NPI: 1225490329
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LE
FirstName: MICHAEL
MiddleName: XUAN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3421 CONCORD RD
Address2:  
City: YORK
State: PA
PostalCode: 174029001
CountryCode: US
TelephoneNumber: 7177214740
FaxNumber: 7177386872
Practice Location
Address1: 169 MARTIN AVE
Address2:  
City: EPHRATA
State: PA
PostalCode: 175221724
CountryCode: US
TelephoneNumber: 7177214740
FaxNumber: 7177386872
Other Information
ProviderEnumerationDate: 03/28/2016
LastUpdateDate: 08/12/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XMD467257PAN Allopathic & Osteopathic PhysiciansHospitalist 
207R00000XMD467257PAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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