Provider Demographics
NPI:1295780955
Name:NYLAND, LEONARD ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:ROBERT
Last Name:NYLAND
Suffix:
Gender:M
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 890195
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0195
Mailing Address - Country:US
Mailing Address - Phone:336-547-1877
Mailing Address - Fax:
Practice Address - Street 1:723 AYERSVILLE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NC
Practice Address - Zip Code:27025-1505
Practice Address - Country:US
Practice Address - Phone:336-427-0281
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD4188OtherMEDCOST
NC63627OtherBCBS NC
NC8963627Medicaid
NC2707312OtherAETNA
NC4838OtherPARTNERS MEDICARE CHOICE
F20476Medicare UPIN
NC8963627Medicaid