Individual
LEESA M MADSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2722 MERRILEE DR, SUITE 230, FAIRFAX, VA 22031-4400
(703) 698-4483
(703) 573-0880
Mailing address
PO BOX 3650, MERRIFIELD, VA 22116-3650
(703) 698-4483
(703) 573-0880
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
0110840790
VA
2085R0202X
Diagnostic Radiology Physician
Primary
0110840790
VA
2085U0001X
Diagnostic Ultrasound Physician
0110840790
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0101305055
—
VA
05
—
0101310791
—
VA
05
—
0101316774
—
VA
05
—
0101317347
—
VA
05
—
0101317371
—
VA
05
—
0101317452
—
VA
05
—
010304989
—
VA
05
—
010316804
—
VA
05
—
010316839
—
VA
05
—
010316847
—
VA
05
—
010316855
—
VA
05
—
010316910
—
VA
05
—
010316936
—
VA
05
—
010317240
—
VA
05
—
010317274
—
VA
05
—
010317312
—
VA
05
—
010317401
—
VA
05
—
010317428
—
VA
05
—
010317452
—
VA
01
—
259998
KAISER PERMANENTE
VA
Enumeration date
07/12/2006
Last updated
04/30/2008
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