Provider Demographics
NPI:1528117801
Name:IRA LEDERMAN MD PC
Entity type:Organization
Organization Name:IRA LEDERMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-583-5826
Mailing Address - Street 1:7312 GRANBY ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3442
Mailing Address - Country:US
Mailing Address - Phone:757-583-5826
Mailing Address - Fax:757-588-2712
Practice Address - Street 1:7312 GRANBY ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3442
Practice Address - Country:US
Practice Address - Phone:757-583-5826
Practice Address - Fax:757-588-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101016600156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
10003994OtherOPTIMA
11392646OtherCAQH
VA188089OtherBLUE CROSS PIN#
188089OtherBCBS
GROUP DE8392OtherRAILROAD MEDICARE
P00319350OtherRAILROAD MEDICARE
11392646OtherCAQH
188089OtherBCBS
10003994OtherOPTIMA