Basic Information
| Provider Information | |||||||||
| NPI: | 1588607998 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEBER | ||||||||
| FirstName: | ERNEST | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 CHERRY ST | ||||||||
| Address2: | SUITE 11511 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191021321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152557822 | ||||||||
| FaxNumber: | 2152557825 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 N BROAD ST | ||||||||
| Address2: | DREXEL EMERGENCY MED HUH | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191021121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157627963 | ||||||||
| FaxNumber: | 2152465793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 04/25/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD072306L | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000922938 | 01 | PA | HIGHMARK BLUE SIELD | OTHER | 0018448090004 | 01 | PROMISE | OTHER | 0867932000 | 01 | PA | KEYSTONE | OTHER | 000922938 | 01 | PA | BS | OTHER | 30049402 | 01 | PA | KEYSTONE MERCY | OTHER | 001844809 | 05 | PA | MEDICAID |