MEDICARE: DR. RICHARD IRA LETVAK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	9701033	NC
2	207R00000X	Internal Medicine Physician	9701033	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20277	OTHER	NC	PARTNERS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	74047	OTHER	NC	MEDCOST
4	7566111	OTHER	NC	AETNA
5	10666	OTHER	NC	BCBS NC

General Provider Information

NPI Number	:	1316902984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD IRA LETVAK M.D.

Provider Business Mailing Address
First Line	:	1200 N ELM ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1004
Country	:	US
Telephone Number	:	336-832-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 GOLF HOUSE ROAD
Second Line	:	COURT E
City	:	WHITSETT
State	:	NC
Zip	:	27377
Country	:	US
Telephone Number	:	336-449-9748
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	09/28/2021

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