Provider Demographics
NPI:1124235437
Name:LETTS, GARY A (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:LETTS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:39 MAPLE TREE AVE
Mailing Address - Street 2:UNIT #10
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-2276
Mailing Address - Country:US
Mailing Address - Phone:203-832-3737
Mailing Address - Fax:203-348-7547
Practice Address - Street 1:148 EAST AVE
Practice Address - Street 2:STE 2D
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5726
Practice Address - Country:US
Practice Address - Phone:203-832-3737
Practice Address - Fax:203-348-7547
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2017-10-13
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Provider Licenses
StateLicense IDTaxonomies
NY235123207ZD0900X
CT043041207ZD0900X, 207ZP0102X, 207ZP0102X
NC2003-01008207ZD0900X
VA0101-235450207ZD0900X
CAA79347207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400119805Medicare PIN