Provider Demographics
NPI:1376764944
Name:THOMPSON-HARGRAVE, LETITIA CANICE (DO)
Entity Type:Individual
Prefix:DR
First Name:LETITIA
Middle Name:CANICE
Last Name:THOMPSON-HARGRAVE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LETITIA
Other - Middle Name:CANICE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:513 E STROOP RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3224
Mailing Address - Country:US
Mailing Address - Phone:937-293-2157
Mailing Address - Fax:937-293-1763
Practice Address - Street 1:513 E STROOP RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3224
Practice Address - Country:US
Practice Address - Phone:937-293-2157
Practice Address - Fax:937-293-1763
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine