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NPI Code Detail

MEDICARE: DR. BYRD STUART LEAVELL JR. MD

MEDICARE: DR. BYRD STUART LEAVELL JR. 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
1174400000XSpecialist0101032293VA

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 : 1386641157
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BYRD STUART LEAVELL JR. MD
Provider Business Mailing Address
First Line : 1139 E HIGH ST
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22902-4856
Country : US
Telephone Number : 434-817-8484
Fax Number :
Provider Business Practice Location Address
First Line : 1139 E HIGH ST
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22902-4856
Country : US
Telephone Number : 434-817-8484
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 01/29/2009

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