Provider Demographics
NPI:1780699413
Name:LEDERMAN, IRA ROBERT (MD)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:ROBERT
Last Name:LEDERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3921 GRANBY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-1201
Mailing Address - Country:US
Mailing Address - Phone:757-583-5826
Mailing Address - Fax:757-588-2712
Practice Address - Street 1:3921 GRANBY ST
Practice Address - Street 2:SUITE A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-1201
Practice Address - Country:US
Practice Address - Phone:757-583-5826
Practice Address - Fax:757-588-2712
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101016600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA172820OtherBLUE CROSS
VA010137225Medicaid
VAB06473Medicare UPIN
VA00W783I0LMedicare PIN