Provider Demographics
NPI:1962499186
Name:LATEEF, BABUR BARI (MD)
Entity Type:Individual
Prefix:DR
First Name:BABUR
Middle Name:BARI
Last Name:LATEEF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14904 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 308
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3908
Mailing Address - Country:US
Mailing Address - Phone:703-494-1766
Mailing Address - Fax:703-494-0980
Practice Address - Street 1:14904 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 308
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3908
Practice Address - Country:US
Practice Address - Phone:703-494-1766
Practice Address - Fax:703-494-0980
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2012-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101232506207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH 14583Medicare UPIN
VA180000930Medicare PIN