Healthcare Provider Details

I. General information

NPI: 1366601692
Provider Name (Legal Business Name): JAMES C LEAGUE-PASCUAL M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP DEPARTMENT OF PEDIATRICS R1.235
FORT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

9300 DEWITT LOOP DEPARTMENT OF PEDIATRICS R1.235
FORT BELVOIR VA
22060-5285
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-1188
  • Fax:
Mailing address:
  • Phone: 571-231-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15665
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberMD-15665
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: