Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 034391 | CT |
Y | 208600000X | Surgeon | 034391 | CT |
N | 2082S0105X | Plastic Hand Surgeon | 034391 | CT |
NPI | 1740608207 |
---|---|
Provider Name | Dr. Jennifer O Letitia |
First Address | Westport, CT 06880-2734 |
Second Address | Westport, CT 06880-2734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 02/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23085 | CSP (01) | CT |
BP6812362 | DEA (01) | CT |