Provider Demographics
NPI:1346384021
Name:JOHN P. LATCHAW MD
Entity Type:Organization
Organization Name:JOHN P. LATCHAW MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGICAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LATCHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-696-1262
Mailing Address - Street 1:100 HIGHLAND ST
Mailing Address - Street 2:SUITE 123
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3881
Mailing Address - Country:US
Mailing Address - Phone:617-696-1262
Mailing Address - Fax:617-696-9584
Practice Address - Street 1:100 HIGHLAND ST
Practice Address - Street 2:SUITE 123
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3881
Practice Address - Country:US
Practice Address - Phone:617-696-1262
Practice Address - Fax:617-696-9584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6176267Medicaid
MAB74442Medicare UPIN
MAJ03338Medicare ID - Type Unspecified