Provider Demographics
NPI:1437122488
Name:LAPHAM, TIMOTHY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ROBERT
Last Name:LAPHAM
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 1:32370 LANKFORD HWY
Mailing Address - Street 2:
Mailing Address - City:PAINTER
Mailing Address - State:VA
Mailing Address - Zip Code:23420-2410
Mailing Address - Country:US
Mailing Address - Phone:703-652-4251
Mailing Address - Fax:703-652-8470
Practice Address - Street 1:32370 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:PAINTER
Practice Address - State:VA
Practice Address - Zip Code:23420-2410
Practice Address - Country:US
Practice Address - Phone:703-652-4251
Practice Address - Fax:703-652-8470
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116014055208600000X
VA0101240684207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1437122488Medicaid
VAVAA101000Medicare PIN
VA1437122488Medicaid