Provider Demographics
NPI:1528279635
Name:LETCHWORTH, TINA RENEE (CPT-ASPT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:RENEE
Last Name:LETCHWORTH
Suffix:
Gender:F
Credentials:CPT-ASPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 FRANKLIN JONES RD
Mailing Address - Street 2:
Mailing Address - City:HOOKERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28538-7168
Mailing Address - Country:US
Mailing Address - Phone:252-286-3893
Mailing Address - Fax:
Practice Address - Street 1:227 KINGOLD BLVD STE B
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-1303
Practice Address - Country:US
Practice Address - Phone:252-747-8181
Practice Address - Fax:252-747-8946
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC246QL0900X, 246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
Not Answered246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy