Provider Demographics
NPI:1457310401
Name:WHITELOCK, LELAND D (MD)
Entity Type:Individual
Prefix:
First Name:LELAND
Middle Name:D
Last Name:WHITELOCK
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 1:560 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3621
Mailing Address - Country:US
Mailing Address - Phone:757-410-9500
Mailing Address - Fax:757-410-9507
Practice Address - Street 1:560 KEMPSVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3621
Practice Address - Country:US
Practice Address - Phone:757-410-9500
Practice Address - Fax:757-410-9507
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101019576207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010027233Medicaid
NC8906917Medicaid
VA010027233Medicaid
VAB09220Medicare UPIN
NC8906917Medicaid