Provider Demographics
NPI:1033469317
Name:REARICK, LEAH ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ROSE
Last Name:REARICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1870 AMHERST ST STE 2B
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2841
Mailing Address - Country:US
Mailing Address - Phone:540-536-6721
Mailing Address - Fax:540-536-6724
Practice Address - Street 1:1870 AMHERST ST STE 2B
Practice Address - Street 2:SUITE 2B
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2841
Practice Address - Country:US
Practice Address - Phone:540-536-6721
Practice Address - Fax:540-536-6724
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2016-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC04783363A00000X
VA0101250786363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant