Provider Demographics
NPI:1689653396
Name:LATHER, ROBERT KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KEITH
Last Name:LATHER
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 1:12701 CHESDIN LANDING DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-3232
Mailing Address - Country:US
Mailing Address - Phone:804-590-1638
Mailing Address - Fax:757-314-7511
Practice Address - Street 1:KENNER ARMY HEALTH CLINIC
Practice Address - Street 2:PRIMARY CARE DIVISION
Practice Address - City:FT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801
Practice Address - Country:US
Practice Address - Phone:804-734-9251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAL0101051489207P00000X
NC116287207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005867894Medicaid
VA1689653396Medicaid
VA005867886Medicaid
G25194Medicare UPIN
VA930002211Medicare PIN
VA005867894Medicaid
VA005867886Medicaid
VA930002212Medicare PIN