Provider Demographics
NPI:1588692586
Name:KROEGER, LEAH DAWN (MD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:DAWN
Last Name:KROEGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:571-284-1140
Mailing Address - Fax:703-753-4730
Practice Address - Street 1:8650 SUDLEY RD
Practice Address - Street 2:SUITE 309
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-366-2799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012396452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAI64449Medicare UPIN
VA011523M63Medicare PIN