Provider Demographics
NPI:1417689605
Name:LEGET, GABRIELLE CATHERINE
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:CATHERINE
Last Name:LEGET
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 1:40729 AVENMAR CT
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2634
Mailing Address - Country:US
Mailing Address - Phone:240-538-6865
Mailing Address - Fax:
Practice Address - Street 1:40729 AVENMAR CT
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2634
Practice Address - Country:US
Practice Address - Phone:240-538-6865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant