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General NPI Number Information
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NPI Number | 1316902984
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Entity Type | Individual
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Provider Name | RICHARD IRA LETVAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 940 GOLF HOUSE ROAD COURT E
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City | WHITSETT
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State | NC
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Zip | 27377
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Country | US
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Telephone | 336-449-9748
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-1004
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Country | US
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Telephone | 336-832-7000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 9701033
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 9701033
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License Number State | NC
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