Provider Demographics
NPI:1447255963
Name:MCLEOD, BRIAN S (MD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:S
Last Name:MCLEOD
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 1:63 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:CT
Mailing Address - Zip Code:06234-1901
Mailing Address - Country:US
Mailing Address - Phone:860-412-0491
Mailing Address - Fax:860-412-0496
Practice Address - Street 1:63 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:CT
Practice Address - Zip Code:06234-1901
Practice Address - Country:US
Practice Address - Phone:860-412-0491
Practice Address - Fax:860-412-0496
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08941174400000X
CT046626208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIG08742Medicare UPIN
RI007004844Medicare ID - Type Unspecified