Provider Demographics
NPI:1851368435
Name:LETAI, ANTHONY GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GEORGE
Last Name:LETAI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:DANA 530B DANA FARBER CANCER INSTITUTE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-632-2348
Mailing Address - Fax:617-582-8160
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:DANA FARBER CANCER INSTITUTE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-4719
Practice Address - Fax:617-632-5168
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA153613207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
14719DFOtherHPHC
3168638OtherMASSHEALTH MASS MEDICAID
3004711OtherUNITED HEALTH CARE
7194892OtherCIGNA
J17828OtherMASSACHUSETTS BCBS
2555994OtherAETNA US HEALTHCARE
65551OtherFALLON COMMUNITY HEALTH P
153613OtherTUFTS
3168638OtherMASSHEALTH MASS MEDICAID
A22808Medicare ID - Type Unspecified