MEDICARE: CHARLES HECHT-LEAVITT MD, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	035284-8011	VA

General Provider Information

NPI Number	:	1194709139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES HECHT-LEAVITT MD, P.C.

Provider Business Mailing Address
First Line	:	4668 PEMBROKE BLVD
Second Line	:	SUITE 117
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6423
Country	:	US
Telephone Number	:	757-671-1144
Fax Number	:	757-671-7299

Provider Business Practice Location Address
First Line	:	4668 PEMBROKE BLVD
Second Line	:	SUITE 117
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6423
Country	:	US
Telephone Number	:	757-671-1144
Fax Number	:	757-671-7299

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/PRESIDENT
Name	:	DR. CHARLES HECHT-LEAVITT
Credential	:	M.D.
Telephone Number	:	757-671-1144

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	03/03/2008

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