Provider Demographics
NPI:1053550517
Name:CHARELNE A. LETCHFORD MD PA
Entity type:Organization
Organization Name:CHARELNE A. LETCHFORD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LETCHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-392-1935
Mailing Address - Street 1:115 LA GRANGE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-9592
Mailing Address - Country:US
Mailing Address - Phone:301-392-1935
Mailing Address - Fax:301-392-1936
Practice Address - Street 1:115 LA GRANGE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-9592
Practice Address - Country:US
Practice Address - Phone:301-392-1935
Practice Address - Fax:301-392-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD46419207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD229251300Medicaid
MD110163418OtherRAILROAD MEDICARE
MD229251300Medicaid
MDF97612Medicare UPIN