Basic Information
Provider Information | |||||||||
NPI: | 1275644239 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LEAHMAN | ||||||||
FirstName: | COURTENAY | ||||||||
MiddleName: | ELIZABETH | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GORDON | ||||||||
OtherFirstName: | COURTENAY | ||||||||
OtherMiddleName: | ELIZABETH | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 91734 | ||||||||
Address2: |   | ||||||||
City: | RICHMOND | ||||||||
State: | VA | ||||||||
PostalCode: | 232911734 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8043586100 | ||||||||
FaxNumber: | 8043427619 | ||||||||
Practice Location | |||||||||
Address1: | 1250 E MARSHALL ST | ||||||||
Address2: | ANESTHESIOLOGY | ||||||||
City: | RICHMOND | ||||||||
State: | VA | ||||||||
PostalCode: | 232985051 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8048289160 | ||||||||
FaxNumber: | 8048288300 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/31/2006 | ||||||||
LastUpdateDate: | 04/07/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101236901 | VA | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
No ID Information.