Basic Information
| Provider Information | |||||||||
| NPI: | 1316501919 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBSTER | ||||||||
| FirstName: | LEAH | ||||||||
| MiddleName: | MEGHAN GRADY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 KIMEL FOREST DR | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271036074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367161331 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1814 WESTCHESTER DR STE 301 | ||||||||
| Address2: | |||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272627369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022025 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2019 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | LL82138 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2022-01643 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.