Healthcare Provider Details

I. General information

NPI: 1932110855
Provider Name (Legal Business Name): LAWRENCE GENE LEICHTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 E KILN CREEK PARKWAY
NEWPORT NEWS VA
23602-9700
US

IV. Provider business mailing address

PO BOX 4548
VIRGINIA BEACH VA
23454-0548
US

V. Phone/Fax

Practice location:
  • Phone: 757-425-1969
  • Fax: 757-425-1822
Mailing address:
  • Phone: 757-425-1969
  • Fax: 957-425-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number0101042384
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: