Provider Demographics
NPI:1467564005
Name:LETNER, IVAN E JR (CP)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:E
Last Name:LETNER
Suffix:JR
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:612 RIO RD W
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1412
Mailing Address - Country:US
Mailing Address - Phone:434-973-6209
Mailing Address - Fax:434-973-1774
Practice Address - Street 1:612 RIO RD W
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1412
Practice Address - Country:US
Practice Address - Phone:434-973-6209
Practice Address - Fax:434-973-1774
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA106977OtherANTHEM
VA91-3255-4Medicare NSC
VA00349130001Medicare NSC