Healthcare Provider Details

I. General information

NPI: 1255675054
Provider Name (Legal Business Name): LINDA C MCLEOD, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 FAIRLAWN DRIVE
CAMDEN SC
29020
US

IV. Provider business mailing address

1009 FAIRLAWN DRIVE
CAMDEN SC
29020
US

V. Phone/Fax

Practice location:
  • Phone: 803-432-2540
  • Fax: 803-432-5431
Mailing address:
  • Phone: 803-432-2540
  • Fax: 803-432-5431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA C MCLEOD
Title or Position: PRESIDENT
Credential: MD
Phone: 803-432-2540