Provider Demographics
NPI:1821084955
Name:LATSCH, MICHAEL STEPHEN
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:LATSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 MARSH RD
Mailing Address - Street 2:STORE 505
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4581
Mailing Address - Country:US
Mailing Address - Phone:302-793-0432
Mailing Address - Fax:302-793-0400
Practice Address - Street 1:11 S BRIDGE STREET PLAZA
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-4911
Practice Address - Country:US
Practice Address - Phone:410-392-0800
Practice Address - Fax:410-392-0815
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012062L225100000X
MD22742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALA1648260OtherBCBS
MD138135ZBL8Medicare PIN
PALA1648260OtherBCBS