Provider Demographics
NPI:1912970484
Name:LEROY, ALBERT G JR (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:G
Last Name:LEROY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9735 KINCEY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-9118
Mailing Address - Country:US
Mailing Address - Phone:704-414-2870
Mailing Address - Fax:704-414-2860
Practice Address - Street 1:1780 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1194
Practice Address - Country:US
Practice Address - Phone:803-327-1116
Practice Address - Fax:803-327-6872
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC6625208800000X
NC30198208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC066252Medicaid
SC279869OtherMAMSI
SC760688OtherGREAT WEST HLTHCARE
SC0411169OtherAETNA
SC26995OtherMEDCOST
NC89136H1Medicaid
NC136H1OtherBCBS OF NC
SC1905788OtherUNITED HEALTHCARE
NC136H1OtherBCBS OF NC
NC89136H1Medicaid
SC066252Medicaid
SC279869OtherMAMSI
SCC851281456Medicare PIN