Provider Demographics
NPI:1164603890
Name:LEGARDA, RAMON HERNANDEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:HERNANDEZ
Last Name:LEGARDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-2721
Mailing Address - Country:US
Mailing Address - Phone:914-395-1474
Mailing Address - Fax:914-793-3098
Practice Address - Street 1:23 MILLARD AVE
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-2721
Practice Address - Country:US
Practice Address - Phone:914-395-1474
Practice Address - Fax:914-793-3098
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149944208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00847274Medicaid
B10925Medicare UPIN
NYZOD701Medicare PIN