Provider Demographics
NPI:1053065078
Name:LAATIRIS, ADAM SAID
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:SAID
Last Name:LAATIRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 KENMORE AVE APT 1017
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1116
Mailing Address - Country:US
Mailing Address - Phone:202-372-6627
Mailing Address - Fax:
Practice Address - Street 1:3261 THEODORE R HAGANS DR NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-4317
Practice Address - Country:US
Practice Address - Phone:202-372-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider