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: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 LIBBIE AVE
RICHMOND VA
23226-2615
US

IV. Provider business mailing address

417 LIBBIE AVE
RICHMOND VA
23226-2615
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-1953
  • Fax: 804-282-1046
Mailing address:
  • Phone: 804-288-1953
  • Fax: 804-282-1046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: