MEDICARE: DENNIS P LEGOLVAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	2009-01866	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013915776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS P LEGOLVAN MD

Provider Business Mailing Address
First Line	:	PO BOX 6241
Second Line	:
City	:	CHRISTIANSBURG
State	:	VA
Zip	:	24068-6241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 CARTHAGE ST
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-4162
Country	:	US
Telephone Number	:	919-774-2270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/19/2012

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Directions to “ DENNIS P LEGOLVAN MD” Practice Location

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