MEDICARE: MARY TERESA LEGENZA M.D.

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	208600000X	Surgery Physician	25804	WV

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
2	000000213230	OTHER	KY	BLUE SHIELD

General Provider Information

NPI Number	:	1427033224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY TERESA LEGENZA M.D.

Provider Business Mailing Address
First Line	:	1400 HAL GREER BLVD
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-4114
Country	:	US
Telephone Number	:	304-399-6556
Fax Number	:	304-399-6554

Provider Business Practice Location Address
First Line	:	1400 HAL GREER BLVD
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-4114
Country	:	US
Telephone Number	:	304-399-6556
Fax Number	:	304-399-6554

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	12/06/2021

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