Healthcare Provider Details

I. General information

NPI: 1619557485
Provider Name (Legal Business Name): ASHLEY LEGG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 NORTHERN BLVD STE K
SOUTH ABINGTON TOWNSHIP PA
18411-8799
US

IV. Provider business mailing address

790 NORTHERN BLVD STE K
SOUTH ABINGTON TOWNSHIP PA
18411-8799
US

V. Phone/Fax

Practice location:
  • Phone: 570-586-4141
  • Fax:
Mailing address:
  • Phone: 570-586-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOS026100
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS026100
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: