MEDICARE: DR. LEELAMMA GEORGE M.D.

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
1	207R00000X	Internal Medicine Physician	0101235226	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	421599648	OTHER	VA	HUMANA GOLD CHOICE
2	000701250	OTHER	VA	AETNA-NON-HMO
3	2885821	OTHER	VA	CIGNA
4	421599648	OTHER	VA	TRICARE
5	466030	OTHER	VA	ANTHEM
6	2130410	OTHER	VA	FIRST HEALTH
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	3302383	OTHER	VA	AETNA-HMO

General Provider Information

NPI Number	:	1306886007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEELAMMA GEORGE M.D.

Provider Business Mailing Address
First Line	:	215 TEMPLE AVE
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2827
Country	:	US
Telephone Number	:	804-526-8411
Fax Number	:	804-526-4321

Provider Business Practice Location Address
First Line	:	215 TEMPLE AVE
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2827
Country	:	US
Telephone Number	:	804-526-8411
Fax Number	:	804-526-4321

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	09/05/2012

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