Provider Demographics
NPI:1922009604
Name:MCLEOD, DONALD (PA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:MCLEOD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 MELROSE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-1604
Mailing Address - Country:US
Mailing Address - Phone:910-615-3200
Mailing Address - Fax:910-615-3201
Practice Address - Street 1:3308 MELROSE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1604
Practice Address - Country:US
Practice Address - Phone:910-615-3200
Practice Address - Fax:910-615-3201
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ16433Medicare UPIN
NC2752062AMedicare PIN
NC2760890Medicare PIN
NC2760890AMedicare PIN