Provider Demographics
NPI:1144276445
Name:LEATHERMAN, HUGH KENNETH JR (MD)
Entity type:Individual
Prefix:DR
First Name:HUGH
Middle Name:KENNETH
Last Name:LEATHERMAN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3320 WAKE FOREST RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7300
Mailing Address - Country:US
Mailing Address - Phone:919-526-1717
Mailing Address - Fax:919-790-0108
Practice Address - Street 1:3320 WAKE FOREST RD
Practice Address - Street 2:SUITE 320
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7300
Practice Address - Country:US
Practice Address - Phone:919-790-5500
Practice Address - Fax:919-790-0108
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-07-07
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Provider Licenses
StateLicense IDTaxonomies
NC27226208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7951321Medicaid
NC7951321Medicaid
NCC85090Medicare UPIN