Basic Information
| Provider Information | |||||||||
| NPI: | 1295754562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEITNER | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 S CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281125614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042839068 | ||||||||
| FaxNumber: | 7042834705 | ||||||||
| Practice Location | |||||||||
| Address1: | 1428 ELLEN ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MONROE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281125173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042894361 | ||||||||
| FaxNumber: | 7042834705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 30830 | NC | Y | Other Service Providers | Specialist |
No ID Information.