Healthcare Provider Details

I. General information

NPI: 1235135815
Provider Name (Legal Business Name): LELAND T GILMORE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 HINSON FARM RD STE 301
ALEXANDRIA VA
22306-3405
US

IV. Provider business mailing address

8101 HINSON FARM RD STE 301
ALEXANDRIA VA
22306-3405
US

V. Phone/Fax

Practice location:
  • Phone: 703-560-3773
  • Fax: 703-799-0050
Mailing address:
  • Phone: 703-560-3773
  • Fax: 703-799-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103000826
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: