Healthcare Provider Details

I. General information

NPI: 1245437789
Provider Name (Legal Business Name): LETICIA OTCHERE-DARKO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST # ST3
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

333 CEDAR ST # ST3
NEW HAVEN CT
06510-3206
US

V. Phone/Fax

Practice location:
  • Phone: 37-852-8022
  • Fax: 203-785-6664
Mailing address:
  • Phone: 203-785-2802
  • Fax: 37-856-6642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number66819
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number19912
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: