Basic Information
| Provider Information | |||||||||
| NPI: | 1518592682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAN LEEUWEN | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | VCUHS GMEA BOX 980257 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232980509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048289783 | ||||||||
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| Practice Location | |||||||||
| Address1: | VCUHS DEPT OF INTERNAL MEDICINE RESIDENCY 980509 | ||||||||
| Address2: | 1250 E MARSHALL ST | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232980509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048288786 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2020 | ||||||||
| LastUpdateDate: | 06/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.