Provider Demographics
NPI:1427056530
Name:LEGERE, BRIAN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:LEGERE
Suffix:
Gender:M
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 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:910-343-1924
Practice Address - Street 1:1090 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7353
Practice Address - Country:US
Practice Address - Phone:910-662-8550
Practice Address - Fax:910-343-1924
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000514207RP1001X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4828877OtherUNITEDHEALTHCARE PROVIDER
NC89126T3Medicaid
NC126T3OtherBCBS OF NC PROVIDER NUMB
NC290012882OtherRAILROAD MEDICARE PROVIDE
NC98045OtherMEDCOST PROVIDER NUMBER
NC290012882OtherRAILROAD MEDICARE PROVIDE
NC2280502Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER