Provider Demographics
NPI:1548721806
Name:ATLANTIC SURGICAL ASSISTANTS, INC
Entity type:Organization
Organization Name:ATLANTIC SURGICAL ASSISTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEGARE
Authorized Official - Suffix:
Authorized Official - Credentials:CSA/LSA
Authorized Official - Phone:757-353-9603
Mailing Address - Street 1:4656 LARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5817
Mailing Address - Country:US
Mailing Address - Phone:888-322-6432
Mailing Address - Fax:888-329-6432
Practice Address - Street 1:4656 LARKWOOD DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5817
Practice Address - Country:US
Practice Address - Phone:888-322-6432
Practice Address - Fax:888-329-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty