Provider Demographics
NPI:1366475386
Name:WARSHAUER, LEO VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:VICTOR
Last Name:WARSHAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1403 AUDUBON BLVD STE A1
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6705
Mailing Address - Country:US
Mailing Address - Phone:910-395-8001
Mailing Address - Fax:910-395-8002
Practice Address - Street 1:1403 AUDUBON BLVD STE A1
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6705
Practice Address - Country:US
Practice Address - Phone:910-395-8001
Practice Address - Fax:910-395-8002
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8985824Medicaid
NC8985824Medicaid
NCE76851Medicare UPIN