Provider Demographics
NPI:1346038890
Name:MCCULLOUGH, LEONARD
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 OLD LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6822
Mailing Address - Country:US
Mailing Address - Phone:336-813-9325
Mailing Address - Fax:
Practice Address - Street 1:4110 OLD LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-6822
Practice Address - Country:US
Practice Address - Phone:336-813-9325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)