Healthcare Provider Details

I. General information

NPI: 1760481568
Provider Name (Legal Business Name): CARLA B MACLEOD MD & ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 02/17/2010
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 630984
BALTIMORE MD
21263-0984
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number21D0947364
License Number StateMD

VIII. Authorized Official

Name: DR. CARLA BELTRAN MACLEOD
Title or Position: OWNER
Credential: MD
Phone: 304-926-4707