Provider Demographics
NPI:1942265988
Name:LEGARRETA, EDWARD ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ANDREW
Last Name:LEGARRETA
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 1:1301 N FOREST RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3277
Mailing Address - Country:US
Mailing Address - Phone:716-633-2203
Mailing Address - Fax:716-633-7738
Practice Address - Street 1:1301 N FOREST RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3277
Practice Address - Country:US
Practice Address - Phone:716-633-2203
Practice Address - Fax:716-633-7738
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124124-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY441182737OtherRAILROAD MEDICARE
NY161149444OtherTAX ID
NY00624162Medicaid
NY00010102403OtherUNIVERA
NY0800088OtherIHA
NY0005075298008OtherBCBS
NY00624162Medicaid
NY0005075298008OtherBCBS
NY0820580004Medicare NSC