Healthcare Provider Details

I. General information

NPI: 1386987808
Provider Name (Legal Business Name): JOSEPH T LEEDS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 JEFFERSON PARK AVE
CHARLOTTESVILLE VA
22908-8160
US

IV. Provider business mailing address

PO BOX 749112
ATLANTA GA
30374-9112
US

V. Phone/Fax

Practice location:
  • Phone: 800-543-8814
  • Fax: 434-982-0722
Mailing address:
  • Phone:
  • Fax: 434-972-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101272512
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: