Provider Demographics
NPI:1831193721
Name:LEIGHTON, STEPHEN LESHER (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LESHER
Last Name:LEIGHTON
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 1:1430 HSA LANE
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101
Mailing Address - Country:US
Mailing Address - Phone:336-723-9002
Mailing Address - Fax:336-722-3780
Practice Address - Street 1:1430 HSA LANE
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101
Practice Address - Country:US
Practice Address - Phone:336-723-9002
Practice Address - Fax:336-722-3780
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8951627Medicaid
NCC81300Medicare UPIN
NC202499EMedicare ID - Type Unspecified