Provider Demographics
NPI:1720130941
Name:SAVOLA, KRISTEN LETSON (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LETSON
Last Name:SAVOLA
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 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:57 N MEDICAL PARK DR STE 109
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2353
Practice Address - Country:US
Practice Address - Phone:540-213-2531
Practice Address - Fax:540-213-2534
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62827207N00000X
VA0101235583207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1010235383OtherMEDICARE ID
VA1720130941Medicaid
VAGC1100Medicare PIN
VA1720130941Medicaid