Individual
DAVID MICHAEL LEEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 602658, CHARLOTTE, NC 28260-2658
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
103499
NC
363A00000X
Physician Assistant
Primary
103499
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7925613
AETNA
NC
01
—
B7667
MEDCOST
NC
Enumeration date
12/01/2005
Last updated
09/29/2020
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