Provider Demographics
NPI:1932216306
Name:LEAMAN, JASON A (PA)
Entity Type:Individual
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First Name:JASON
Middle Name:A
Last Name:LEAMAN
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Gender:M
Credentials:PA
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Mailing Address - Street 1:5420 WADE PARK BLVD
Mailing Address - Street 2:STE 106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-4188
Mailing Address - Country:US
Mailing Address - Phone:919-851-2174
Mailing Address - Fax:919-854-7774
Practice Address - Street 1:4905 GREEN RD
Practice Address - Street 2:STE. 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-2805
Practice Address - Country:US
Practice Address - Phone:919-872-5411
Practice Address - Fax:919-872-5904
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2010-06-14
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Provider Licenses
StateLicense IDTaxonomies
NC103821363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2766959Medicare PIN