Provider Demographics
NPI:1023205515
Name:LATHAM-SOLOMON, VICKI B (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:B
Last Name:LATHAM-SOLOMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:115 S 15TH ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-4252
Mailing Address - Country:US
Mailing Address - Phone:804-398-3460
Mailing Address - Fax:804-344-0980
Practice Address - Street 1:13901 COALFIELD COMMONS PL STE 201
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-1219
Practice Address - Country:US
Practice Address - Phone:804-420-1200
Practice Address - Fax:804-344-0980
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101242349207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN
VAC06778OtherGROUP PTAN
VA016059P84Medicare PIN