Provider Demographics
NPI:1639101256
Name:LEGUM, LARRY L (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:L
Last Name:LEGUM
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 1:113 COASTAL WAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4603
Mailing Address - Country:US
Mailing Address - Phone:757-547-9401
Mailing Address - Fax:757-547-9403
Practice Address - Street 1:113 COASTAL WAY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4603
Practice Address - Country:US
Practice Address - Phone:757-547-9401
Practice Address - Fax:757-547-9403
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021942174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB05870Medicare UPIN