Provider Demographics
NPI:1760460265
Name:LE, LAC K (MD)
Entity Type:Individual
Prefix:DR
First Name:LAC
Middle Name:K
Last Name:LE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5816 SPINNAKER COVE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2127
Mailing Address - Country:US
Mailing Address - Phone:804-524-7429
Mailing Address - Fax:804-524-7069
Practice Address - Street 1:26317 W. WASHINGTON ST
Practice Address - Street 2:CENTRAL STATE HOSPITAL
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803
Practice Address - Country:US
Practice Address - Phone:804-524-7429
Practice Address - Fax:804-524-7069
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101034585208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC47400Medicare UPIN