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NPI Code Detail

MEDICARE: DR. DEBORAH I LEAVENS MD

MEDICARE: DR. DEBORAH I LEAVENS 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 Physician0101032359VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080182909OTHERVARR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407840788
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEBORAH I LEAVENS MD
Provider Business Mailing Address
First Line : 555 HERNDON PKWY
Second Line : STE 100
City : HERNDON
State : VA
Zip : 20170-5276
Country : US
Telephone Number : 703-481-1505
Fax Number : 703-742-8793
Provider Business Practice Location Address
First Line : 555 HERNDON PKWY
Second Line : STE 100
City : HERNDON
State : VA
Zip : 20170-5276
Country : US
Telephone Number : 703-481-1505
Fax Number : 703-742-8793
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2005
Last Update Date : 11/27/2023

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Directions to “ DR. DEBORAH I LEAVENS MD” Practice Location

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