Provider Demographics
NPI:1306941133
Name:GOUDAS, LEONIDAS ATHANASIOS (MD)
Entity type:Individual
Prefix:DR
First Name:LEONIDAS
Middle Name:ATHANASIOS
Last Name:GOUDAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ENOLA RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4608
Mailing Address - Country:US
Mailing Address - Phone:828-608-6360
Mailing Address - Fax:828-433-2735
Practice Address - Street 1:300 ENOLA RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4608
Practice Address - Country:US
Practice Address - Phone:828-608-6360
Practice Address - Fax:828-433-2735
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300795208600000X
NC2003-00795207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY89134XNMedicaid
NC134XNOtherBCBS
NC134XNOtherBCBS
NC2020178Medicare ID - Type Unspecified