Provider Demographics
NPI:1578508289
Name:EAPEN, LATA MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:LATA
Middle Name:MARY
Last Name:EAPEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2008 BROOK HILL MANOR CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7962
Mailing Address - Country:US
Mailing Address - Phone:636-527-3744
Mailing Address - Fax:
Practice Address - Street 1:1 JEFFERSON BARRACKS DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4181
Practice Address - Country:US
Practice Address - Phone:314-894-5770
Practice Address - Fax:314-894-5775
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20033010052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine