Provider Demographics
NPI:1235268210
Name:GLEATON, KENOSHA D (MD)
Entity Type:Individual
Prefix:DR
First Name:KENOSHA
Middle Name:D
Last Name:GLEATON
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 1:2048 CHARLIE HALL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5830
Mailing Address - Country:US
Mailing Address - Phone:843-804-6010
Mailing Address - Fax:843-804-6011
Practice Address - Street 1:2048 CHARLIE HALL BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5830
Practice Address - Country:US
Practice Address - Phone:843-804-6010
Practice Address - Fax:843-804-6011
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32540207V00000X
NC135029207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC325401Medicaid
SCAA51889223Medicare PIN