Healthcare Provider Details

I. General information

NPI: 1568629954
Provider Name (Legal Business Name): LEONARD R NYLAND, MD,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 AYERSVILLE RD
MADISON NC
27025-1505
US

IV. Provider business mailing address

723 AYERSVILLE RD
MADISON NC
27025-1505
US

V. Phone/Fax

Practice location:
  • Phone: 336-427-0281
  • Fax: 336-427-8084
Mailing address:
  • Phone: 336-427-0281
  • Fax: 336-427-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number147952
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. LEONARD ROBERT NYLAND
Title or Position: OWNER
Credential: M.D.
Phone: 336-427-0281