Provider Demographics
NPI:1225822992
Name:MARTIN, LEAH AMBROSE (PA)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:AMBROSE
Last Name:MARTIN
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Gender:
Credentials:PA
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Mailing Address - Street 1:7130 GLEN FOREST DR STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3754
Mailing Address - Country:US
Mailing Address - Phone:804-662-6138
Mailing Address - Fax:804-282-2601
Practice Address - Street 1:6600 W BROAD ST STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1709
Practice Address - Country:US
Practice Address - Phone:804-288-4084
Practice Address - Fax:804-282-2601
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110010733363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant