Provider Demographics
NPI:1437114204
Name:LETTIERE, MICHAEL ANTHONY SR (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:LETTIERE
Suffix:SR
Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:316 BUGBEE DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4202
Mailing Address - Country:US
Mailing Address - Phone:315-788-5113
Mailing Address - Fax:
Practice Address - Street 1:PEDIATRIC ASSOCIATES OF WATERTOWN
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-782-4391
Practice Address - Fax:315-788-8319
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY5247363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant