Basic Information
| Provider Information | |||||||||
| NPI: | 1720041205 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEA | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7007 HARBOUR VIEW BLVD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234352719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572152745 | ||||||||
| FaxNumber: | 7572152728 | ||||||||
| Practice Location | |||||||||
| Address1: | 13609 CARROLLTON BLVD | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | CARROLLTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233143214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572388751 | ||||||||
| FaxNumber: | 7572388750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 01/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0102049953 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5600677 | 05 | VA | MEDICAID |