Provider Demographics
NPI:1396435020
Name:DANGERFIELD, LEON (R-CPRS)
Entity type:Individual
Prefix:MR
First Name:LEON
Middle Name:
Last Name:DANGERFIELD
Suffix:
Gender:M
Credentials:R-CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MEADOWSPRING RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-5640
Mailing Address - Country:US
Mailing Address - Phone:804-499-9677
Mailing Address - Fax:
Practice Address - Street 1:108 MEADOWSPRING RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23223
Practice Address - Country:US
Practice Address - Phone:804-499-9677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0735000361175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist