Provider Demographics
NPI:1770677510
Name:AMATEAU, LEIGH M (PA)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:M
Last Name:AMATEAU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5875 BREMO RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1934
Mailing Address - Country:US
Mailing Address - Phone:804-484-3713
Mailing Address - Fax:804-323-0770
Practice Address - Street 1:5875 BREMO RD
Practice Address - Street 2:SUITE 303
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-484-3713
Practice Address - Fax:804-323-0770
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110001527363AM0700X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P63069Medicare UPIN
VA970000667Medicare PIN
VAVAA100632Medicare PIN
VA009170V83Medicare ID - Type Unspecified
VA970000666Medicare PIN
VA970000668Medicare PIN