Healthcare Provider Details

I. General information

NPI: 1881285948
Provider Name (Legal Business Name): LEAH ELIZABETH KROHN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 HINSON FARM RD STE 107
ALEXANDRIA VA
22306-3400
US

IV. Provider business mailing address

1477 GIRARD ST NW UNIT 4
WASHINGTON DC
20009-6364
US

V. Phone/Fax

Practice location:
  • Phone: 703-224-9999
  • Fax:
Mailing address:
  • Phone: 860-933-9103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007669
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: