Provider Demographics
NPI:1285652446
Name:LETTIERI, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:LETTIERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4133 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BROAD TOP
Mailing Address - State:PA
Mailing Address - Zip Code:16621-9001
Mailing Address - Country:US
Mailing Address - Phone:814-635-2916
Mailing Address - Fax:814-635-2918
Practice Address - Street 1:6674 TOWNE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-6934
Practice Address - Country:US
Practice Address - Phone:814-643-1232
Practice Address - Fax:814-643-4267
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD054433L207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001512907-0017Medicaid
G15606Medicare UPIN