Provider Demographics
NPI:1184887788
Name:LEAK, BYRON CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:BYRON
Middle Name:CHRISTOPHER
Last Name:LEAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:980-487-3751
Mailing Address - Fax:980-487-3294
Practice Address - Street 1:706 W KING ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-2708
Practice Address - Country:US
Practice Address - Phone:980-487-3751
Practice Address - Fax:980-487-3294
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-01423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917911Medicaid
SCNC1299Medicaid
NC1184887788Medicaid
SCNC1299Medicaid
NC5917911Medicaid
NCNCI948CMedicare PIN
NCNCI948FMedicare PIN
NCNCI948EMedicare PIN