Provider Demographics
NPI:1073253308
Name:LEACH, DANIEL FRIEL III (MD, MENG)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:FRIEL
Last Name:LEACH
Suffix:III
Gender:M
Credentials:MD, MENG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 LEE ST BOX 800383
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0816
Mailing Address - Country:US
Mailing Address - Phone:434-924-5191
Mailing Address - Fax:434-924-2464
Practice Address - Street 1:1215 LEE ST STE 800383
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-3022
Practice Address - Country:US
Practice Address - Phone:434-924-5191
Practice Address - Fax:434-924-2464
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116037507390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program