MEDICARE: RODNEY OWEN LEACOCK 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	2084N0400X	Neurology Physician	200300373	NC
2	2084V0102X	Vascular Neurology Physician	35018	SC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356436703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODNEY OWEN LEACOCK M.D.

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	803-434-6412
Fax Number	:	803-296-7330

Provider Business Practice Location Address
First Line	:	3 RICHLAND MEDICAL PARK DR STE 310
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6862
Country	:	US
Telephone Number	:	803-434-8323
Fax Number	:	803-296-8326

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/10/2025

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Directions to “ RODNEY OWEN LEACOCK M.D.” Practice Location

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