Provider Demographics
NPI:1396735742
Name:LATTIN, GARY M (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:LATTIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:145 N 6TH ST
Mailing Address - Street 2:1ST FL
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3096
Mailing Address - Country:US
Mailing Address - Phone:610-378-2440
Mailing Address - Fax:610-378-2441
Practice Address - Street 1:145 N 6TH ST
Practice Address - Street 2:1ST FL
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3096
Practice Address - Country:US
Practice Address - Phone:610-378-2440
Practice Address - Fax:610-378-2441
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2015-07-28
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Provider Licenses
StateLicense IDTaxonomies
PAMD-013438-E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006587740007Medicaid
B39818Medicare UPIN
PA0006587740007Medicaid