Individual
DR. ISAAC LEAKE WORNOM III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1630 WILKES RIDGE PKWY STE 201, RICHMOND, VA 23233-7460
(804) 285-4115
(804) 673-6714
Mailing address
14401 SOMMERVILLE CT, MIDLOTHIAN, VA 23113-6836
(804) 285-4115
(804) 673-6714
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
0101043924
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009999558
—
VA
Enumeration date
06/18/2006
Last updated
11/28/2018
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