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NPI Code Detail

MEDICARE: JEANNINE M LEADBEATER MD

MEDICARE: JEANNINE M LEADBEATER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician0101230002VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043273832
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANNINE M LEADBEATER MD
Provider Business Mailing Address
First Line : 3235 BRIDGE RD
Second Line : SUITE 15
City : SUFFOLK
State : VA
Zip : 23435-1778
Country : US
Telephone Number : 757-606-1656
Fax Number : 757-606-1657
Provider Business Practice Location Address
First Line : 3241 WESTERN BRANCH BLVD
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23321-5260
Country : US
Telephone Number : 757-686-3508
Fax Number : 757-686-0541
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2006
Last Update Date : 07/18/2011

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