Provider Demographics
NPI:1467058636
Name:LEGRAND, MARY FAITH
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FAITH
Last Name:LEGRAND
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 1:5517 S MADISON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-9539
Mailing Address - Country:US
Mailing Address - Phone:440-298-1914
Mailing Address - Fax:
Practice Address - Street 1:5517 S MADISON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-9539
Practice Address - Country:US
Practice Address - Phone:440-298-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver