Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1700X | Ocularist | ||
Y | 224P00000X | Prosthetist | 84-190 |
NPI | 1538374848 |
---|---|
Provider Name | Mr. Joseph A Legrand |
First Address | Broomall, PA 19008-3654 |
Second Address | Broomall, PA 19008-3654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 09/11/2021 |