| Dr. Letitia Tierney | |
|
10 Courtney Dr Charleston WV 25304-2699 | |
| (304) 344-2345 | |
| (304) 400-4645 |
| Full Name | Dr. Letitia Tierney |
|---|---|
| Speciality | Internal Medicine |
| Location | 10 Courtney Dr, Charleston, West Virginia |
| Authorized Official Name and Position | Letitia Elaine Tierney (SOLE MEMBER) |
| Authorized Official Contact | 3043442345 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Letitia Tierney 10 Courtney Dr Charleston WV 25304-2699 Ph: (304) 344-2345 | Dr. Letitia Tierney 10 Courtney Dr Charleston WV 25304-2699 Ph: (304) 344-2345 |
| NPI Number | 1104559160 |
|---|---|
| Provider Enumeration Date | 07/07/2022 |
| Last Update Date | 08/04/2022 |
| Medicare PECOS PAC ID | 3173991478 |
|---|---|
| Medicare Enrollment ID | O20221117000911 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104559160 | NPI | - | NPPES |
| 3810017636 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Letitia Tierney |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679792493 PECOS PAC ID: 0547390296 Enrollment ID: I20100608000020 |
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