Provider Demographics
NPI:1548221286
Name:LE, PHUOC H (MD)
Entity type:Individual
Prefix:
First Name:PHUOC
Middle Name:H
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BLACKHORSE HILL RD # 111
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-2040
Mailing Address - Country:US
Mailing Address - Phone:610-384-7711
Mailing Address - Fax:610-466-2227
Practice Address - Street 1:1400 BLACKHORSE HILL RD # 111
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2040
Practice Address - Country:US
Practice Address - Phone:610-384-7711
Practice Address - Fax:610-466-2227
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014605090001Medicaid
PA1014605090001Medicaid
PAF70366Medicare UPIN
PA117768Medicare PIN