Provider Demographics
NPI:1386032647
Name:ALEXANDER, LEAH MILES (PA-C)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MILES
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:MICHELLE
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 33369
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28233-3369
Mailing Address - Country:US
Mailing Address - Phone:704-364-8100
Mailing Address - Fax:704-365-2073
Practice Address - Street 1:1450 MATTHEWS TOWNSHIP PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2387
Practice Address - Country:US
Practice Address - Phone:704-841-1444
Practice Address - Fax:704-849-2520
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1386032647Medicaid
NCNCM342AMedicare PIN