Healthcare Provider Details

I. General information

NPI: 1295780955
Provider Name (Legal Business Name): LEONARD ROBERT NYLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 AYERSVILLE RD
MADISON NC
27025-1505
US

IV. Provider business mailing address

PO BOX 890195
CHARLOTTE NC
28289-0195
US

V. Phone/Fax

Practice location:
  • Phone: 336-427-0281
  • Fax:
Mailing address:
  • Phone: 336-547-1877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34423
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: