Provider Demographics
NPI:1275559536
Name:DORAN, LETTIE MARIE (MD)
Entity type:Individual
Prefix:
First Name:LETTIE
Middle Name:MARIE
Last Name:DORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LETTIE
Other - Middle Name:MARIE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:416 WIDDINGTON LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6699
Mailing Address - Country:US
Mailing Address - Phone:516-993-7671
Mailing Address - Fax:
Practice Address - Street 1:416 WIDDINGTON LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-6699
Practice Address - Country:US
Practice Address - Phone:516-993-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216921207Q00000X
NC144636208M00000X
NC2007-01747208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02199351Medicaid
NY080167894Medicare ID - Type Unspecified
NY02199351Medicaid