Provider Demographics
NPI:1790739258
Name:LEARMAN, LEE ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ANDREW
Last Name:LEARMAN
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 1:902 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4404
Mailing Address - Country:US
Mailing Address - Phone:540-985-9862
Mailing Address - Fax:
Practice Address - Street 1:902 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4404
Practice Address - Country:US
Practice Address - Phone:540-985-9862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065484A207V00000X
CAG71945207V00000X
VA0101267494207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200924650Medicaid
CA00G719450Medicaid
IN200924650Medicaid
IN896330XXXMedicare PIN
CA00G719450Medicare ID - Type Unspecified