Provider Demographics
NPI:1205877198
Name:TRANTHAM, LEAH S (MD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:S
Last Name:TRANTHAM
Suffix:
Gender:F
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:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:149 SAINT JAMES AVE
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2923
Practice Address - Country:US
Practice Address - Phone:843-553-0526
Practice Address - Fax:843-266-1997
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080180923OtherRR MEDICARE
SCT10477Medicaid
SC080180698OtherRR MEDICARE
SCP00813620OtherRAILROAD MEDICARE ID-RSFPN
SC080180923OtherRR MEDICARE
SCP00813620OtherRAILROAD MEDICARE ID-RSFPN
SC1497874424Medicare PIN
SCT10477Medicaid
SCF574416795Medicare PIN
SCF574419223Medicare PIN