Basic Information
| Provider Information | |||||||||
| NPI: | 1932192473 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWEENEY | ||||||||
| FirstName: | LESLEY | ||||||||
| MiddleName: | JAYE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GAYDOS | ||||||||
| OtherFirstName: | LESLEY | ||||||||
| OtherMiddleName: | J | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2500 BERNVILLE RD | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196059453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103782440 | ||||||||
| FaxNumber: | 6103782441 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 N 6TH ST | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196013096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103782440 | ||||||||
| FaxNumber: | 6103782441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 02/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 054727 | GA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD444828 | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 102714697 | 05 | PA | MEDICAID | 30120389 | 01 | PA | AMERIHEALTH MERCY - WMG | OTHER | 30120471 | 01 | PA | AMERIHEALTH MERCY - YH | OTHER | 711582297A | 05 | GA | MEDICAID | 2705367 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 418501 | 01 | PA | UPMC | OTHER | 1608898 | 01 | PA | GATEWAY | OTHER |