Provider Demographics
NPI:1700146222
Name:LITEL, JENNY LEANNE (DO)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:LEANNE
Last Name:LITEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:LEANNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:620 JOHN PAUL JONES CIR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708-2111
Mailing Address - Country:US
Mailing Address - Phone:757-953-1689
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-1689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-86975207ZP0102X, 207ZC0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0008XAllopathic & Osteopathic PhysiciansPathologyClinical Informatics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN