Provider Demographics
NPI:1255315081
Name:AMIR, ABDUL LATIF (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:LATIF
Last Name:AMIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 SOUTHPARK BLVD
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3610
Mailing Address - Country:US
Mailing Address - Phone:804-376-8383
Mailing Address - Fax:
Practice Address - Street 1:1602 SKIPWITH RD
Practice Address - Street 2:HOSPITALISTS DOCTOR HENRICO DOCTORS HOSPITAL
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5205
Practice Address - Country:US
Practice Address - Phone:804-289-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236604207RH0002X, 207RS0012X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1255315081Medicaid
VA139451OtherANTHEM
VA302011OtherANTHEM BCBS
VAP00601104OtherMEDICARE RAILROAD
VAP00136200OtherMEDICARE RR
VA10130930Medicaid
VAP00136200OtherMEDICARE RR
VA139451OtherANTHEM
VA10130930Medicare PIN