Provider Demographics
NPI:1538984356
Name:LEACH, THOMAS (RD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:LEACH
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1464 LEWIS LANDING AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4483
Mailing Address - Country:US
Mailing Address - Phone:706-296-2345
Mailing Address - Fax:
Practice Address - Street 1:1464 LEWIS LANDING AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-4483
Practice Address - Country:US
Practice Address - Phone:706-296-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered