Provider Demographics
NPI:1326568957
Name:GHAFFARI, LEILA MARAL (DO)
Entity type:Individual
Prefix:DR
First Name:LEILA
Middle Name:MARAL
Last Name:GHAFFARI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 ATLEE RD
Mailing Address - Street 2:MOB2 SUITE 330
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116
Mailing Address - Country:US
Mailing Address - Phone:804-764-6000
Mailing Address - Fax:804-764-7351
Practice Address - Street 1:8260 ATLEE RD
Practice Address - Street 2:MOB2 SUITE 330
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116
Practice Address - Country:US
Practice Address - Phone:804-764-6000
Practice Address - Fax:804-764-7351
Is Sole Proprietor?:No
Enumeration Date:2017-06-24
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA272859207R00000X
VA01022065172084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology