Provider Demographics
NPI:1255386264
Name:LEGHART, GREGORY F (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:LEGHART
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 1:8254 ATLEE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-1844
Mailing Address - Country:US
Mailing Address - Phone:804-342-4335
Mailing Address - Fax:804-342-4316
Practice Address - Street 1:8254 ATLEE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1844
Practice Address - Country:US
Practice Address - Phone:804-342-4335
Practice Address - Fax:804-342-4316
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045881208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6834418Medicaid
VA6834418Medicaid