Healthcare Provider Details

I. General information

NPI: 1952483505
Provider Name (Legal Business Name): EDWARD LATHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 N BROADWAY
YONKERS NY
10701-1301
US

IV. Provider business mailing address

PO BOX 634863
CINCINNATI OH
45263-0042
US

V. Phone/Fax

Practice location:
  • Phone: 914-964-4349
  • Fax: 937-534-0166
Mailing address:
  • Phone: 800-290-5292
  • Fax: 937-534-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number72835
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number216423-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: