Provider Demographics
NPI:1891844809
Name:GEARY, LEON WALLACE (MD)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:WALLACE
Last Name:GEARY
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 1:3916 BEN FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2383
Mailing Address - Country:US
Mailing Address - Phone:919-956-9300
Mailing Address - Fax:919-595-8467
Practice Address - Street 1:3916 BEN FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2383
Practice Address - Country:US
Practice Address - Phone:919-956-9300
Practice Address - Fax:919-595-8467
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C81200Medicare ID - Type Unspecified
NC202319FMedicare ID - Type Unspecified
NC2578501Medicare PIN
NC202319GMedicare PIN