Healthcare Provider Details

I. General information

NPI: 1730829128
Provider Name (Legal Business Name): CORY LETENDRE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3461 S COUNTY TRL STE 101
EAST GREENWICH RI
02818-1463
US

IV. Provider business mailing address

PO BOX 229
WAKEFIELD RI
02880-0229
US

V. Phone/Fax

Practice location:
  • Phone: 401-471-6740
  • Fax: 401-471-6753
Mailing address:
  • Phone: 401-788-3929
  • Fax: 401-788-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01456
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: