Active NPI
Mauricio Gallegos Leal, MD
- Internal Medicine Physician
- Charleston, SC
National Provider Identifier
1770330854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- LL92713
- Practice address
- 169 Ashley Ave
Room 202 Main Hospital, Msc333
Charleston, SC 29425 - Phone
- (843) 792-2731
- NPI assigned
- May 6, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 13-3971298 | NY | |
| Internal Medicine Physician | 207R00000X | LL92713 | SC | Primary |
Addresses
Primary practice location
169 Ashley Ave
Room 202 Main Hospital, Msc333
Charleston, SC 29425
Mailing address
169 Ashley Ave
Room 202 Main Hospital, Msc333
Charleston, SC 29425
Other practice location 1
550 1st Ave
New York, NY 10016-6402
Phone (212) 263-5506
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13-3971298 | NY | MD | Student in an Organized Health Care Education/Training Program |
Interoperability endpoints
- mgallegosleal713090@nyumc.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744416000000",
"number": "1770330854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "169 ASHLEY AVE",
"address_2": "ROOM 202 MAIN HOSPITAL, MSC333",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "29425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "169 ASHLEY AVE",
"address_2": "ROOM 202 MAIN HOSPITAL, MSC333",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "29425",
"telephone_number": "843-792-2731"
}
],
"practiceLocations": [
{
"address_1": "550 1st Ave",
"address_purpose": "LOCATION",
"city": "New York",
"state": "NY",
"postal_code": "100166402",
"country_code": "US",
"telephone_number": "212-263-5506",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GALLEGOS LEAL",
"first_name": "MAURICIO",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-06",
"last_updated": "2025-04-12",
"certification_date": "2025-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NY",
"license": "13-3971298",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "SC",
"license": "LL92713",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.