Provider Demographics
NPI:1265453963
Name:EDWARDS, LEONEL (MD)
Entity Type:Individual
Prefix:
First Name:LEONEL
Middle Name:
Last Name:EDWARDS
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 1:1456 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-3824
Mailing Address - Country:US
Mailing Address - Phone:352-365-4562
Mailing Address - Fax:352-789-7085
Practice Address - Street 1:1456 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3824
Practice Address - Country:US
Practice Address - Phone:352-365-4562
Practice Address - Fax:352-365-4562
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL113888207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG97398Medicare UPIN