Provider Demographics
NPI:1659347474
Name:GALVAN, LEONARD B (PA C)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:B
Last Name:GALVAN
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13205 BOOKER T WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:VA
Mailing Address - Zip Code:24101-3947
Mailing Address - Country:US
Mailing Address - Phone:540-719-1815
Mailing Address - Fax:540-719-2867
Practice Address - Street 1:13205 BOOKER T WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:HARDY
Practice Address - State:VA
Practice Address - Zip Code:24101-3947
Practice Address - Country:US
Practice Address - Phone:540-719-1815
Practice Address - Fax:540-719-2867
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001029363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q01776Medicare UPIN