Provider Demographics
NPI:1396987780
Name:PETER C. LATKIN MD PC
Entity type:Organization
Organization Name:PETER C. LATKIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:LATKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:703-534-2445
Mailing Address - Street 1:6201 LEESBURG PIKE
Mailing Address - Street 2:#300
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044
Mailing Address - Country:US
Mailing Address - Phone:703-534-2445
Mailing Address - Fax:703-538-5575
Practice Address - Street 1:6201 LEESBURG PIKE
Practice Address - Street 2:#300
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044
Practice Address - Country:US
Practice Address - Phone:703-534-2445
Practice Address - Fax:703-538-5575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023974207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6756166Medicaid
VAB93937Medicare UPIN
VA6756166Medicaid