Provider Demographics
NPI:1114192010
Name:THOMAS M LELAND MD PA
Entity Type:Organization
Organization Name:THOMAS M LELAND MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MIKELL
Authorized Official - Last Name:LELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-571-7337
Mailing Address - Street 1:1483 TOBIAS GADSON BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-8702
Mailing Address - Country:US
Mailing Address - Phone:843-571-7337
Mailing Address - Fax:843-571-6911
Practice Address - Street 1:578 LONE TREE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8170
Practice Address - Country:US
Practice Address - Phone:843-881-2020
Practice Address - Fax:843-881-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7912207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3104Medicaid
TN5842Medicare PIN