Provider Demographics
NPI:1477508273
Name:MCLEOD, LIZABETH ANN (MD)
Entity type:Individual
Prefix:
First Name:LIZABETH
Middle Name:ANN
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:249 N GROVE MEDICAL PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4227
Practice Address - Country:US
Practice Address - Phone:864-582-8135
Practice Address - Fax:864-573-9757
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14975208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCI49752Medicaid
SC149752Medicaid
SCF44430Medicare ID - Type Unspecified
SCI49752Medicaid
SCF444307951Medicare PIN
F44430Medicare UPIN