Provider Demographics
NPI:1043596133
Name:LEICHT, VICTORIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:LEICHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:KESSELHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6888 GRAND RIVER RD
Mailing Address - Street 2:STE 220
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9345
Mailing Address - Country:US
Mailing Address - Phone:810-220-4422
Mailing Address - Fax:810-220-1123
Practice Address - Street 1:537 STANTON CHRISTIANA RD STE 209
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2148
Practice Address - Country:US
Practice Address - Phone:302-225-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000792363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant