Provider Demographics
NPI:1346582624
Name:LEGER, ELISE JENNIFER
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:JENNIFER
Last Name:LEGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7041
Mailing Address - Country:US
Mailing Address - Phone:336-273-3661
Mailing Address - Fax:336-273-9438
Practice Address - Street 1:802 GREEN VALLEY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7041
Practice Address - Country:US
Practice Address - Phone:336-273-3661
Practice Address - Fax:336-273-9438
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-00686207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology