Healthcare Provider Details

I. General information

NPI: 1013176957
Provider Name (Legal Business Name): CARLA B. MACLEOD M.D. & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18207A FLOWER HILL WAY
GAITHERSBURG MD
20879-5331
US

IV. Provider business mailing address

PO BOX 1738
WAKE FOREST NC
27588-1738
US

V. Phone/Fax

Practice location:
  • Phone: 301-926-4707
  • Fax: 301-926-4708
Mailing address:
  • Phone: 301-926-4707
  • Fax: 301-926-4708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number21D0947364
License Number StateMD

VIII. Authorized Official

Name: CARLA B MACLEOD
Title or Position: DIRECTOR
Credential: MD
Phone: 301-926-4707