Provider Demographics
NPI:1093876260
Name:MCGUIRE, LEAH HEWETT (PA C)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:HEWETT
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:RYAN
Other - Last Name:HEWETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA C
Mailing Address - Street 1:2920 HIGHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-0010
Mailing Address - Country:US
Mailing Address - Phone:877-498-4490
Mailing Address - Fax:
Practice Address - Street 1:3009 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1214
Practice Address - Country:US
Practice Address - Phone:919-232-5020
Practice Address - Fax:919-232-5021
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00661363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-00661OtherSTATE MEDICAL LICENSE