Provider Demographics
NPI:1497746051
Name:AAMODT, LEONARD WORTLEY (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:WORTLEY
Last Name:AAMODT
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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-438-1314
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:240 LUCY DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8036
Practice Address - Country:US
Practice Address - Phone:540-438-1314
Practice Address - Fax:540-438-0797
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA50215207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6213006Medicaid
VA160001593Medicare ID - Type Unspecified
VA6213006Medicaid