Provider Demographics
NPI:1902825417
Name:EVERETT, LEIGH A (PA)
Entity Type:Individual
Prefix:MS
First Name:LEIGH
Middle Name:A
Last Name:EVERETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:7250 PARKWAY DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076
Mailing Address - Country:US
Mailing Address - Phone:443-949-0814
Mailing Address - Fax:443-292-6814
Practice Address - Street 1:110 KINGSLEY LN
Practice Address - Street 2:SUITE 106
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4614
Practice Address - Country:US
Practice Address - Phone:757-889-5735
Practice Address - Fax:757-889-5742
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110840858363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA278246OtherANTHEM
MD212140900Medicaid
MF0806832OtherDEA CERTIFICATE
MD212140900Medicaid
970011518Medicare ID - Type UnspecifiedRAILROAD MEDICARE