Provider Demographics
NPI:1093743890
Name:LEGGAT, JOHN E JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:LEGGAT
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:90 PRESIDENTIAL PLZ
Mailing Address - Street 2:FIRM C
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2240
Mailing Address - Country:US
Mailing Address - Phone:315-464-3834
Mailing Address - Fax:315-464-3837
Practice Address - Street 1:90 PRESIDENTIAL PLZ
Practice Address - Street 2:FIRM C
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2240
Practice Address - Country:US
Practice Address - Phone:315-464-3834
Practice Address - Fax:315-464-3837
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-06-16
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Provider Licenses
StateLicense IDTaxonomies
NY207457207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01753557Medicaid
NYP00649905Medicare PIN
NY01753557Medicaid