Provider Demographics
NPI:1376623454
Name:LEITZ, CHRISTINE K (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:K
Last Name:LEITZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 SPOTSYLVANIA AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-8609
Mailing Address - Country:US
Mailing Address - Phone:540-373-1331
Mailing Address - Fax:540-373-1124
Practice Address - Street 1:10401 SPOTSYLVANIA AVE
Practice Address - Street 2:STE 203
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-8609
Practice Address - Country:US
Practice Address - Phone:540-373-1331
Practice Address - Fax:540-373-1124
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001346363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV3210BMedicare PIN