Provider Demographics
NPI:1245437789
Name:OTCHERE-DARKO, LETICIA (MD)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:OTCHERE-DARKO
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 1:333 CEDAR ST # ST3
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:203-785-2802
Mailing Address - Fax:037-856-6642
Practice Address - Street 1:333 CEDAR ST # ST3
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3206
Practice Address - Country:US
Practice Address - Phone:037-852-8022
Practice Address - Fax:203-785-6664
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT66819207L00000X
MS19912207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00657496OtherRAILROAD MEDICARE
MSP01402440OtherRR MEDICARE
AL179012Medicaid
MS08087069Medicaid
MSP00657496OtherRAILROAD MEDICARE
AL179012Medicaid