Provider Demographics
NPI:1508906256
Name:LEONARD, ELIZABETH MAY (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MAY
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 LEEDS AVE
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-7469
Mailing Address - Country:US
Mailing Address - Phone:843-529-2698
Mailing Address - Fax:
Practice Address - Street 1:3841 LEEDS AVE
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7469
Practice Address - Country:US
Practice Address - Phone:843-529-2698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0844792084P0800X
SC136582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC13658OtherSTATE LICENSE
SC327877Medicaid
SC3344Medicare UPIN