Provider Demographics
NPI:1891801189
Name:LETOURNEAU, ANN LUCY (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LUCY
Last Name:LETOURNEAU
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 1:96 TERRYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1388
Mailing Address - Country:US
Mailing Address - Phone:631-473-4200
Mailing Address - Fax:631-473-4995
Practice Address - Street 1:96 TERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1388
Practice Address - Country:US
Practice Address - Phone:631-473-4200
Practice Address - Fax:631-473-4995
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1970472086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY59J091Medicare PIN
F96789Medicare UPIN