Provider Demographics
NPI:1306886007
Name:GEORGE, LEELAMMA (MD)
Entity type:Individual
Prefix:DR
First Name:LEELAMMA
Middle Name:
Last Name:GEORGE
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 1:215 TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2827
Mailing Address - Country:US
Mailing Address - Phone:804-526-8411
Mailing Address - Fax:804-526-4321
Practice Address - Street 1:215 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2827
Practice Address - Country:US
Practice Address - Phone:804-526-8411
Practice Address - Fax:804-526-4321
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235226207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA421599648OtherHUMANA GOLD CHOICE
VA000701250OtherAETNA-NON-HMO
VA2885821OtherCIGNA
VA421599648OtherTRICARE
VA466030OtherANTHEM
VA2130410OtherFIRST HEALTH
VA010029180Medicaid
VA3302383OtherAETNA-HMO
VA2885821OtherCIGNA
VA421599648OtherHUMANA GOLD CHOICE