Provider Demographics
NPI:1740324789
Name:LEMON, LATRINA C (MD)
Entity type:Individual
Prefix:
First Name:LATRINA
Middle Name:C
Last Name:LEMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23173-0009
Mailing Address - Country:US
Mailing Address - Phone:804-289-8064
Mailing Address - Fax:
Practice Address - Street 1:363 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23173-0009
Practice Address - Country:US
Practice Address - Phone:804-289-8064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1740324789Medicaid
VA1740324789Medicaid
VAP01136084Medicare PIN