Provider Demographics
NPI:1497711808
Name:LETTIERI, JOHN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:LETTIERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E WOOD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3004
Mailing Address - Country:US
Mailing Address - Phone:864-583-1222
Mailing Address - Fax:864-582-5154
Practice Address - Street 1:100 E WOOD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3004
Practice Address - Country:US
Practice Address - Phone:864-583-1222
Practice Address - Fax:864-582-5154
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14855208200000X
NC39968208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL2214Medicaid
SCTL2214Medicaid