Individual
LEAH MARIE VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5 FIRST VILLAGE DR, PINEHURST, NC 28374-9495
(910) 295-6831
Mailing address
5 FIRST VILLAGE DR, PINEHURST, NC 28374-9495
(321) 591-9367
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
0010-14407
NC
363AM0700X
Medical Physician Assistant
Primary
—
NC
Other
Enumeration date
07/15/2024
Last updated
08/22/2024
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