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NPI Code Detail

MEDICARE: DR. TONYA S MCLEOD M.D.

MEDICARE: DR. TONYA S MCLEOD M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician200201125NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598742603
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TONYA S MCLEOD M.D.
Provider Business Mailing Address
First Line : 1072 X RAY DR STE B
Second Line :
City : GASTONIA
State : NC
Zip : 28054-7488
Country : US
Telephone Number : 704-671-1094
Fax Number : 704-671-1095
Provider Business Practice Location Address
First Line : 5815 BLAKENEY PARK DR
Second Line : SUITE 100
City : CHARLOTTE
State : NC
Zip : 28277-5731
Country : US
Telephone Number : 704-542-2220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 06/23/2020

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