Provider Demographics
NPI:1275266900
Name:THARP, LEAH ROSE
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ROSE
Last Name:THARP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 LAKE POWELL RD APT 102
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3700
Mailing Address - Country:US
Mailing Address - Phone:703-505-9824
Mailing Address - Fax:
Practice Address - Street 1:3203 LAKE POWELL RD APT 102
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3700
Practice Address - Country:US
Practice Address - Phone:703-505-9824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty