Provider Demographics
NPI:1700989860
Name:LAMM, TITA CUA (MD)
Entity Type:Individual
Prefix:DR
First Name:TITA
Middle Name:CUA
Last Name:LAMM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TITA
Other - Middle Name:TANZO
Other - Last Name:CUA-NG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 403751
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-3751
Mailing Address - Country:US
Mailing Address - Phone:804-967-9225
Mailing Address - Fax:804-545-1686
Practice Address - Street 1:4355 INNSLAKE DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6742
Practice Address - Country:US
Practice Address - Phone:804-967-9225
Practice Address - Fax:804-545-1686
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86119207ZP0102X
TXL8404207ZP0102X
VA0101044893207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6401120OtherGHI
E66954Medicare UPIN