Provider Demographics
NPI:1568691079
Name:GARY A. LETTS, M.D. LLC
Entity Type:Organization
Organization Name:GARY A. LETTS, M.D. LLC
Other - Org Name:CORIUM DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LETTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-832-3737
Mailing Address - Street 1:148 EAST AVE STE 2D
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5726
Mailing Address - Country:US
Mailing Address - Phone:203-348-7546
Mailing Address - Fax:203-348-7547
Practice Address - Street 1:148 EAST AVE STE 2D
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5726
Practice Address - Country:US
Practice Address - Phone:203-348-7546
Practice Address - Fax:203-348-7547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043041207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty