Provider Demographics
NPI:1427588243
Name:GLEASON, MARIAH L (MS)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:L
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:L
Other - Last Name:BRUCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1021 MOREHEAD MEDICAL DR STE 2300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2991
Mailing Address - Country:US
Mailing Address - Phone:980-442-2515
Mailing Address - Fax:
Practice Address - Street 1:1021 MOREHEAD MEDICAL DR STE 2300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2991
Practice Address - Country:US
Practice Address - Phone:980-442-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS