Provider Demographics
NPI:1215196878
Name:LEGRAND, GORDON CUBBERLEY (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:CUBBERLEY
Last Name:LEGRAND
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 1:323 W 96TH ST
Mailing Address - Street 2:APT. 1202
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6191
Mailing Address - Country:US
Mailing Address - Phone:718-920-4295
Mailing Address - Fax:
Practice Address - Street 1:323 W 96TH ST
Practice Address - Street 2:APT. 1202
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6191
Practice Address - Country:US
Practice Address - Phone:718-920-4295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-08
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248807-12084P0800X
CAA1026672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry