Provider Demographics
NPI:1871543900
Name:LEGGE, ANDREA (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LEGGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2940
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-2940
Mailing Address - Country:US
Mailing Address - Phone:360-979-0569
Mailing Address - Fax:360-930-8213
Practice Address - Street 1:19036 FRONT ST NE STE 100
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7354
Practice Address - Country:US
Practice Address - Phone:360-979-0569
Practice Address - Fax:877-805-9505
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8356883Medicaid
8918CHOtherREGENCE BLUESHIELD
WA172269OtherLABOR & INDUSTRIES
P00045628OtherRAILROAD MEDICARE
7146476OtherAETNA
WA8356883Medicaid
G8886732Medicare PIN
H87767Medicare UPIN
WA172269OtherLABOR & INDUSTRIES
WAG8852301Medicare PIN
7146476OtherAETNA
BC7959894OtherDEA
8918CHOtherREGENCE BLUESHIELD
G8887638Medicare PIN