Provider Demographics
NPI:1023145315
Name:MCLEOD, KAREN ANTONNETTE (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANTONNETTE
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANTONNETTE
Other - Last Name:MCLEOD-DELEANEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 746087
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6087
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:8923 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3613
Practice Address - Country:US
Practice Address - Phone:718-765-6000
Practice Address - Fax:347-436-9621
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBM5683493OtherDEA
NYG65505Medicare UPIN