Provider Demographics
NPI:1720019193
Name:LEONARD, ANDRE JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:JOHN
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 1:4114 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6155
Mailing Address - Country:US
Mailing Address - Phone:910-332-0701
Mailing Address - Fax:910-332-0710
Practice Address - Street 1:4114 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6155
Practice Address - Country:US
Practice Address - Phone:910-332-0701
Practice Address - Fax:910-332-0710
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800607207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911484Medicaid
NCG82026Medicare UPIN
NC2256311Medicare ID - Type Unspecified