Provider Demographics
NPI:1730405127
Name:LEAKE, ANDREW EVANS (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:EVANS
Last Name:LEAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 LIBBIE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2615
Mailing Address - Country:US
Mailing Address - Phone:804-288-1953
Mailing Address - Fax:804-282-1046
Practice Address - Street 1:417 LIBBIE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2615
Practice Address - Country:US
Practice Address - Phone:804-288-1953
Practice Address - Fax:804-282-1046
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
VA01012621662086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty