Healthcare Provider Details

I. General information

NPI: 1194787945
Provider Name (Legal Business Name): ELIHU JOSE LEDESMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROANOKE BLVD
SALEM VA
24153-6404
US

IV. Provider business mailing address

147 BOGEY LN
SALEM VA
24153-6858
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-2463
  • Fax:
Mailing address:
  • Phone: 540-375-6538
  • Fax: 540-375-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number0101239570
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: