Provider Demographics
NPI:1144253790
Name:ARAGON, LEAH A (MD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:A
Last Name:ARAGON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 TANNER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5923
Mailing Address - Country:US
Mailing Address - Phone:864-627-1220
Mailing Address - Fax:864-627-1221
Practice Address - Street 1:305 TANNER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5923
Practice Address - Country:US
Practice Address - Phone:864-627-1220
Practice Address - Fax:864-627-1221
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3070Medicaid
SCGP3070Medicaid
SCG489988600Medicare PIN
SC8600Medicare PIN
SC8157Medicare PIN