Basic Information
| Provider Information | |||||||||
| NPI: | 1568196699 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEGACY&GAS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11508 VEIRS MILL RD | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209022519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438059150 | ||||||||
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| Practice Location | |||||||||
| Address1: | HOLY CROSS HOSPITAL | ||||||||
| Address2: | 1500 FOREST GLEN ROAD | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017547000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2022 | ||||||||
| LastUpdateDate: | 07/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | NNWOKA | ||||||||
| AuthorizedOfficialFirstName: | NLEREMCHI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4438059150 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.