Provider Demographics
NPI:1063460707
Name:LEFFLER, CHRISTOPHER THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:THEODORE
Last Name:LEFFLER
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 1:5917 BARNSTABLE CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5766
Mailing Address - Country:US
Mailing Address - Phone:804-828-9315
Mailing Address - Fax:804-828-1010
Practice Address - Street 1:4819 CEDAR BRANCH CT
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6136
Practice Address - Country:US
Practice Address - Phone:804-346-9200
Practice Address - Fax:804-225-8364
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052451207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010030072Medicaid
VA010030072Medicaid
VA00V649C69Medicare PIN
VA200117723OtherGROUP TAX ID NUMBER
VA010030072Medicaid
VAX99059Medicare ID - Type UnspecifiedMEDICARE GROUP UPIN