Provider Demographics
NPI:1528069879
Name:LELAND, THOMAS M (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:LELAND
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 1:1739 MAYBANK HWY
Mailing Address - Street 2:STE T-112
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2103
Mailing Address - Country:US
Mailing Address - Phone:843-696-6988
Mailing Address - Fax:
Practice Address - Street 1:500 CHARLIE HALL BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414
Practice Address - Country:US
Practice Address - Phone:843-696-6988
Practice Address - Fax:843-696-6988
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-05-28
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
SC7912207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528069879OtherNPI
SCGP1246Medicaid
5910Medicare PIN
SCB91910Medicare UPIN
5911Medicare PIN
1528069879OtherNPI
SCGP1246Medicaid