Provider Demographics
NPI:1609855246
Name:LEONARD, BAXTER (MD)
Entity Type:Individual
Prefix:
First Name:BAXTER
Middle Name:
Last Name:LEONARD
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 890273
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0273
Mailing Address - Country:US
Mailing Address - Phone:828-328-2231
Mailing Address - Fax:828-323-1562
Practice Address - Street 1:24 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5045
Practice Address - Country:US
Practice Address - Phone:828-328-2231
Practice Address - Fax:828-323-1562
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18016173000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8951732Medicaid
NCCN8132OtherMEDICARE RAILROAD
NC8951732Medicaid
NCCN8132OtherMEDICARE RAILROAD