Healthcare Provider Details

I. General information

NPI: 1700825593
Provider Name (Legal Business Name): JAMES V LETTERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 KINGS HWY E SUITE 112
FAIRFIELD CT
06825-4867
US

IV. Provider business mailing address

501 KINGS HWY E SUITE 112
FAIRFIELD CT
06825-4867
US

V. Phone/Fax

Practice location:
  • Phone: 203-382-1900
  • Fax: 203-382-0019
Mailing address:
  • Phone: 203-382-1900
  • Fax: 203-382-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number025871
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number025871
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: