Provider Demographics
NPI:1134596646
Name:LEROY CHARLES MD PA
Entity type:Organization
Organization Name:LEROY CHARLES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-784-7014
Mailing Address - Street 1:4849 LAKE WORTH RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3461
Mailing Address - Country:US
Mailing Address - Phone:561-784-7014
Mailing Address - Fax:
Practice Address - Street 1:4849 LAKE WORTH RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3461
Practice Address - Country:US
Practice Address - Phone:561-784-7014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83408207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty