Provider Demographics
NPI:1992862924
Name:LAKATTA, EDWARD GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:GERARD
Last Name:LAKATTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:126 BRIARCLIFF LN
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5553
Mailing Address - Country:US
Mailing Address - Phone:410-879-8782
Mailing Address - Fax:410-558-8150
Practice Address - Street 1:5600 NATHAN SHOCK DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6825
Practice Address - Country:US
Practice Address - Phone:410-558-8202
Practice Address - Fax:410-558-8150
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD935355207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease