Provider Demographics
NPI:1013176957
Name:CARLA B. MACLEOD M.D. & ASSOCIATES LLC
Entity Type:Organization
Organization Name:CARLA B. MACLEOD M.D. & ASSOCIATES LLC
Other - Org Name:CBM PATHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MACLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-926-4707
Mailing Address - Street 1:PO BOX 1738
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27588-1738
Mailing Address - Country:US
Mailing Address - Phone:301-926-4707
Mailing Address - Fax:301-926-4708
Practice Address - Street 1:18207A FLOWER HILL WAY
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-5331
Practice Address - Country:US
Practice Address - Phone:301-926-4707
Practice Address - Fax:301-926-4708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZP0102X
MD21D0947364291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD335205600Medicaid
DCPENDINGMedicare PIN
MDPENDINGMedicaid