Healthcare Provider Details

I. General information

NPI: 1063518215
Provider Name (Legal Business Name): LEONARD V SACKS MB.B.CH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VETERANS AFFAIRS MEDICAL CTR 50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

3719 T ST NW
WASHINGTON DC
20007-2120
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8695
  • Fax:
Mailing address:
  • Phone: 202-965-5851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD19198
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: