Healthcare Provider Details

I. General information

NPI: 1730405127
Provider Name (Legal Business Name): ANDREW EVANS LEAKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2010
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 SHRADER RD
HENRICO VA
23294-4215
US

IV. Provider business mailing address

8135 FOREST LN # 515057
DALLAS TX
75230-2472
US

V. Phone/Fax

Practice location:
  • Phone: 804-264-8783
  • Fax: 804-266-9214
Mailing address:
  • Phone: 804-264-8782
  • Fax: 804-266-9214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101262166
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: