Individual
EDWARD LEGARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RSA
Contact information
Practice address
4656 LARKWOOD DR, VIRGINIA BEACH, VA 23464-5817
(757) 353-9603
Mailing address
4656 LARKWOOD DR, VIRGINIA BEACH, VA 23464-5817
(757) 353-9603
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
0136000017
VA
363AS0400X
Surgical Physician Assistant
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0136000017
REGISTERED SURGICAL ASSISTANT
VA
Enumeration date
12/04/2013
Last updated
09/17/2023
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