Provider Demographics
NPI:1144849142
Name:LETTMAN, MADHUMITA
Entity type:Individual
Prefix:DR
First Name:MADHUMITA
Middle Name:
Last Name:LETTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 W CANTON AVE STE G100
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3050
Mailing Address - Country:US
Mailing Address - Phone:407-901-4086
Mailing Address - Fax:
Practice Address - Street 1:1030 W CANTON AVE STE G100
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3050
Practice Address - Country:US
Practice Address - Phone:407-901-4086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
390200000X
FLOS20449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program