Provider Demographics
NPI:1720041205
Name:LEA, JOYCE LYNN (DO)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:LYNN
Last Name:LEA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7007 HARBOUR VIEW BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2719
Mailing Address - Country:US
Mailing Address - Phone:757-215-2745
Mailing Address - Fax:757-215-2728
Practice Address - Street 1:13609 CARROLLTON BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-3214
Practice Address - Country:US
Practice Address - Phone:757-238-8751
Practice Address - Fax:757-238-8750
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102049953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5600677Medicaid
001617L76Medicare ID - Type Unspecified
E70805Medicare UPIN