Provider Demographics
NPI:1740298272
Name:LEEDIE, LINDA CATHERINE (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:CATHERINE
Last Name:LEEDIE
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 1:2115 EXECUTIVE DR
Mailing Address - Street 2:4A
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2499
Mailing Address - Country:US
Mailing Address - Phone:757-838-8166
Mailing Address - Fax:757-838-8233
Practice Address - Street 1:2115 EXECUTIVE DR
Practice Address - Street 2:4A
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2499
Practice Address - Country:US
Practice Address - Phone:757-838-8166
Practice Address - Fax:757-838-8233
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048559208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006709419Medicaid
VAE86451Medicare UPIN