Provider Demographics
NPI:1356191852
Name:LEACH, HARRIS (DO)
Entity type:Individual
Prefix:
First Name:HARRIS
Middle Name:
Last Name:LEACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SAM SNEAD LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4709
Mailing Address - Country:US
Mailing Address - Phone:757-297-6948
Mailing Address - Fax:
Practice Address - Street 1:825 FAIRFAX AVE FL 4
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8920
Practice Address - Fax:757-446-7452
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program