MEDICARE: LEAH HASKVITZ CRNA

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	174400000X	Specialist	R117999	MD
2	367500000X	Certified Registered Nurse Anesthetist	0024164355	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780681429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH HASKVITZ CRNA

Provider Business Mailing Address
First Line	:	PO BOX 75420
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21275-5420
Country	:	US
Telephone Number	:	703-383-6469
Fax Number	:	703-385-1062

Provider Business Practice Location Address
First Line	:	13350 FRANKLIN FARM RD
Second Line	:	STE 100
City	:	HERNDON
State	:	VA
Zip	:	20171-4091
Country	:	US
Telephone Number	:	703-810-5206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/16/2024

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