Provider Demographics
NPI:1982667101
Name:LADA, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:LADA
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:PO BOX 110977
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-0977
Mailing Address - Country:US
Mailing Address - Phone:907-565-6000
Mailing Address - Fax:866-977-2562
Practice Address - Street 1:3200 PROVIDENCE DR
Practice Address - Street 2:SUITE 248
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4615
Practice Address - Country:US
Practice Address - Phone:907-261-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK49392084N0400X
AK64952084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2060022Medicaid
OH729002OtherBUCKEYE COMMUNITY HEALTH
AKMD0495Medicaid
OH341097565QOtherSUMMACARE
OH90128OtherQUALCHOICE
OH000000127231OtherANTHEM BLUECROSS/BLUESHEI
OH100285OtherKAISER
OH140005608OtherRAILROAD MEDICARE
OHLA0845614Medicare PIN
OH729002OtherBUCKEYE COMMUNITY HEALTH
OH341097565QOtherSUMMACARE
AKMD0495Medicaid
AKK161956Medicare PIN
OH100285OtherKAISER
OHLA0845616Medicare PIN
OHLA0845612Medicare PIN