Provider Demographics
NPI:1992987499
Name:WRIGHT, LETITIA JEANNA (MD)
Entity type:Individual
Prefix:DR
First Name:LETITIA
Middle Name:JEANNA
Last Name:WRIGHT
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 1:4326 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-6425
Mailing Address - Country:US
Mailing Address - Phone:443-562-6621
Mailing Address - Fax:
Practice Address - Street 1:8813 WALTHAM WOODS RD STE 204
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2577
Practice Address - Country:US
Practice Address - Phone:410-882-5088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD69097207R00000X
390200000X
MDD0069097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD023751500Medicaid
MD023751500Medicaid