MEDICARE: DR. LEENA JHA 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
1	174400000X	Specialist	0101252194	VA
2	207R00000X	Internal Medicine Physician	57010872	OH
3	207R00000X	Internal Medicine Physician	4301095002	MI
4	207R00000X	Internal Medicine Physician	0101252194	VA
5	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	4301095002	MI
6	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	0101252194	VA

General Provider Information

NPI Number	:	1417073131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEENA JHA MD

Provider Business Mailing Address
First Line	:	6355 WALKER LN STE 405
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-3250
Country	:	US
Telephone Number	:	703-719-6715
Fax Number	:

Provider Business Practice Location Address
First Line	:	6355 WALKER LN STE 405
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-3250
Country	:	US
Telephone Number	:	703-719-6715
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	10/05/2022

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