Provider Demographics
NPI:1013116599
Name:EDRALIN, LENARD JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:LENARD
Middle Name:JOSEPH
Last Name:EDRALIN
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 1:1621 S MOORINGS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-5344
Mailing Address - Country:US
Mailing Address - Phone:910-352-4702
Mailing Address - Fax:910-251-9428
Practice Address - Street 1:2304 DELANEY RD
Practice Address - Street 2:KNOX CLINIC PEDIATRICS, PLLC
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6013
Practice Address - Country:US
Practice Address - Phone:910-763-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01318173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine