Provider Demographics
NPI:1306857909
Name:LEONCIO, JOSE DABU (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:DABU
Last Name:LEONCIO
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 1:1061 NE WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323
Mailing Address - Country:US
Mailing Address - Phone:757-485-5371
Mailing Address - Fax:757-485-4590
Practice Address - Street 1:1061 NE WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323
Practice Address - Country:US
Practice Address - Phone:757-485-5371
Practice Address - Fax:757-485-4590
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5676380Medicaid
VAC47113Medicare UPIN