Provider Demographics
NPI:1538183942
Name:LEONHARDT, GARY G (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:G
Last Name:LEONHARDT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4300 SAPPHIRE CT STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9079
Mailing Address - Country:US
Mailing Address - Phone:252-830-7561
Mailing Address - Fax:252-413-0932
Practice Address - Street 1:203 GOVERNMENT CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8198
Practice Address - Country:US
Practice Address - Phone:252-413-1637
Practice Address - Fax:252-317-0316
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC392962084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20Medicare UPIN