Provider Demographics
NPI:1720514797
Name:LIEBRECHT, LOREN KAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:KAYE
Last Name:LIEBRECHT
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 1:320 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7114
Mailing Address - Country:US
Mailing Address - Phone:276-233-3535
Mailing Address - Fax:
Practice Address - Street 1:320 N 24TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7114
Practice Address - Country:US
Practice Address - Phone:276-233-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA1720514797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program