Provider Demographics
NPI:1982048849
Name:LATHAM, ANNMARIE ASIS (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:ASIS
Last Name:LATHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 BECKETT RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOGAN TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1766
Mailing Address - Country:US
Mailing Address - Phone:856-467-6400
Mailing Address - Fax:856-467-1033
Practice Address - Street 1:499 BECKETT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LOGAN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1766
Practice Address - Country:US
Practice Address - Phone:856-467-6400
Practice Address - Fax:856-467-1033
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00306200363A00000X
PAMA056009363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical