Provider Demographics
NPI:1356469134
Name:LEAL, BRIAN LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LAWRENCE
Last Name:LEAL
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:PO BOX 50520
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-0520
Mailing Address - Country:US
Mailing Address - Phone:843-552-4240
Mailing Address - Fax:843-552-4121
Practice Address - Street 1:1101 BOWMAN RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3213
Practice Address - Country:US
Practice Address - Phone:843-552-4240
Practice Address - Fax:843-552-4121
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058796282NR1301X
SC30505207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA29738036Medicare PIN
SCAA29732986Medicare PIN
SCAA29732987Medicare PIN