Provider Demographics
NPI:1871597849
Name:LEONARD, CHARLES D (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:LEONARD
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 1:12511 ELENA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2221
Mailing Address - Country:US
Mailing Address - Phone:505-823-9767
Mailing Address - Fax:
Practice Address - Street 1:12511 ELENA DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2221
Practice Address - Country:US
Practice Address - Phone:505-823-9767
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM73-158207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine