Provider Demographics
NPI:1437189149
Name:PELTZER, LETICIA IBARRA (MD)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:IBARRA
Last Name:PELTZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26208 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-7504
Mailing Address - Country:US
Mailing Address - Phone:276-451-3044
Mailing Address - Fax:276-451-3045
Practice Address - Street 1:26208 LEE HWY
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7504
Practice Address - Country:US
Practice Address - Phone:276-451-3044
Practice Address - Fax:276-451-3045
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD40247207Y00000X
VA0101238767207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG96601Medicare UPIN