Provider Demographics
NPI:1750680153
Name:LEGAGNEUR, NAOMIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:NAOMIE
Middle Name:
Last Name:LEGAGNEUR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:NAOMIE
Other - Middle Name:
Other - Last Name:ST PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:122 HEATHER RDG
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4644
Mailing Address - Country:US
Mailing Address - Phone:203-873-9092
Mailing Address - Fax:
Practice Address - Street 1:46 ALBION ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-2602
Practice Address - Country:US
Practice Address - Phone:203-330-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00940213E00000X
PASC006227213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008067803Medicaid