Provider Demographics
NPI:1902802077
Name:THORN, LEANNA F (MD)
Entity Type:Individual
Prefix:DR
First Name:LEANNA
Middle Name:F
Last Name:THORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LEANNA
Other - Middle Name:J
Other - Last Name:FOGLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-744-4757
Practice Address - Fax:252-744-4125
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC021183207P00000X
NC97-01354207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790608VMedicaid
NC150H0OtherBCBS
SCT53215Medicaid
NC150H0OtherBCBS
SCT53215Medicaid