Provider Demographics
NPI:1144265778
Name:UPTON, LETITIA (MD)
Entity type:Individual
Prefix:DR
First Name:LETITIA
Middle Name:
Last Name:UPTON
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 1:5 PARK PL
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1910
Mailing Address - Country:US
Mailing Address - Phone:617-332-5611
Mailing Address - Fax:
Practice Address - Street 1:5 PARK PL
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1910
Practice Address - Country:US
Practice Address - Phone:617-332-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA444562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE05687OtherBC/BS OF MA
MA044456OtherTUFTS HEALTH PLAN
MA044456OtherTUFTS HEALTH PLAN