Provider Demographics
NPI:1407858244
Name:LATTUADA, CHARLES P JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:P
Last Name:LATTUADA
Suffix:JR
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 1:901 LEIGHTON AVE
Mailing Address - Street 2:SUITE 602
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5700
Mailing Address - Country:US
Mailing Address - Phone:256-238-1011
Mailing Address - Fax:256-238-4366
Practice Address - Street 1:901 LEIGHTON AVE
Practice Address - Street 2:SUITE 602
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5700
Practice Address - Country:US
Practice Address - Phone:256-238-1011
Practice Address - Fax:256-238-4366
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18922207RI0200X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL158742Medicaid