Healthcare Provider Details

I. General information

NPI: 1659768158
Provider Name (Legal Business Name): PATRICK DOYLE LEIDIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 NE GATEWAY CT NE STE 100
CONCORD NC
28025-2411
US

IV. Provider business mailing address

1085 NE GATEWAY CT NE
CONCORD NC
28025-2406
US

V. Phone/Fax

Practice location:
  • Phone: 704-707-2200
  • Fax: 704-707-2203
Mailing address:
  • Phone: 704-944-6330
  • Fax: 704-707-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2018-03061
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: