Healthcare Provider Details

I. General information

NPI: 1740264803
Provider Name (Legal Business Name): LEAH H HINKLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 CORPORATE PARK DR
FOREST VA
24551-2238
US

IV. Provider business mailing address

PO BOX 389
FOREST VA
24551-0389
US

V. Phone/Fax

Practice location:
  • Phone: 434-525-6964
  • Fax: 434-525-4035
Mailing address:
  • Phone: 434-525-6964
  • Fax: 434-352-5403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101221372
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: