Provider Demographics
NPI:1669430963
Name:LEIDEL, BERNADETTE ESPIRITU (MD)
Entity type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:ESPIRITU
Last Name:LEIDEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 VISTA CIR
Mailing Address - Street 2:UNIT 503
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1069
Mailing Address - Country:US
Mailing Address - Phone:757-481-2489
Mailing Address - Fax:
Practice Address - Street 1:6345 CENTER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4105
Practice Address - Country:US
Practice Address - Phone:757-461-4027
Practice Address - Fax:757-461-8821
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049029208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1669430963Medicaid
320856OtherANTHEM BLUE CROSS
13931OtherOPTIMA HEALTH CARE