Provider Demographics
NPI:1538374848
Name:LEGRAND, JOSEPH A (BCO)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:LEGRAND
Suffix:
Gender:M
Credentials:BCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 REED RD STE 7
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3654
Mailing Address - Country:US
Mailing Address - Phone:215-496-1307
Mailing Address - Fax:215-496-1693
Practice Address - Street 1:590 REED RD STE 7
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3654
Practice Address - Country:US
Practice Address - Phone:215-496-1307
Practice Address - Fax:215-496-1693
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1700X
84-190224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist