Individual
MARK P LEGOLVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
706 GREEN VALLEY RD STE 104, GREENSBORO, NC 27408-7043
(336) 387-2500
(336) 387-2501
Mailing address
PO BOX 30369, WINSTON SALEM, NC 27130-0369
(336) 306-5777
(336) 999-8889
Taxonomy
Speciality
Code
Description
License number
State
207ZH0000X
Hematology (Pathology) Physician
2019-02503
NC
207ZH0000X
Hematology (Pathology) Physician
Primary
DO00627
RI
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
2019-02503
NC
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
DO00627
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019-02503
STATE LICENSE
NC
Enumeration date
04/20/2007
Last updated
10/15/2025
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