Healthcare Provider Details

I. General information

NPI: 1770555096
Provider Name (Legal Business Name): RICHARD P. LEGGETT MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 BRAEBURN DR
SALEM VA
24153-7304
US

IV. Provider business mailing address

1914 BRAEBURN DR
SALEM VA
24153-7304
US

V. Phone/Fax

Practice location:
  • Phone: 540-776-1018
  • Fax: 540-776-6523
Mailing address:
  • Phone: 540-776-1018
  • Fax: 540-776-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number0101049756
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number0101049756
License Number StateVA

VIII. Authorized Official

Name: RICHARD PRESTON LEGGETT
Title or Position: PRESIDENT
Credential: MD
Phone: 540-776-1018