Healthcare Provider Details

I. General information

NPI: 1013116599
Provider Name (Legal Business Name): LENARD JOSEPH EDRALIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 DELANEY RD KNOX CLINIC PEDIATRICS, PLLC
WILMINGTON NC
28403-6013
US

IV. Provider business mailing address

1621 S MOORINGS DR
WILMINGTON NC
28405-5344
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-3378
  • Fax:
Mailing address:
  • Phone: 910-352-4702
  • Fax: 910-251-9428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number2009-01318
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: