MEDICARE: LEEANN B SKLADAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	00285	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063416329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEEANN B SKLADAN M.D.

Provider Business Mailing Address
First Line	:	703 NEWMAN RD
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5239
Country	:	US
Telephone Number	:	252-633-2900
Fax Number	:	252-633-9609

Provider Business Practice Location Address
First Line	:	703 NEWMAN RD
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5239
Country	:	US
Telephone Number	:	252-633-2900
Fax Number	:	252-633-9609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	12/06/2010

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