Healthcare Provider Details

I. General information

NPI: 1528096831
Provider Name (Legal Business Name): BRIAN CURTIS LEACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 RUTLEDGE AVENUE DEPT OF DERMATOLOGY & DERMATOLOGIC SURGERY
CHARLESTON SC
29425
US

IV. Provider business mailing address

135 RUTLEDGE AVENUE DEPT OF DERMATOLOGY & DERMATOLOGIC SURGERY
CHARLESTON SC
29425
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-3021
  • Fax:
Mailing address:
  • Phone: 853-792-3021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number021882
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number29232
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number29232
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number29232
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: