Basic Information
| Provider Information | |||||||||
| NPI: | 1316902984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LETVAK | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | IRA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368327000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 940 GOLF HOUSE ROAD | ||||||||
| Address2: | COURT E | ||||||||
| City: | WHITSETT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364499748 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 9701033 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 9701033 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 20277 | 01 | NC | PARTNERS MEDICARE | OTHER | 8910666 | 05 | NC | MEDICAID | 74047 | 01 | NC | MEDCOST | OTHER | 7566111 | 01 | NC | AETNA | OTHER | 10666 | 01 | NC | BCBS NC | OTHER |