Healthcare Provider Details

I. General information

NPI: 1063522290
Provider Name (Legal Business Name): PETER C LATKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 LEESBURG PIKE #300
FALLS CHURCH VA
22044
US

IV. Provider business mailing address

6201 LEESBURG PIKE #300
FALLS CHURCH VA
22044
US

V. Phone/Fax

Practice location:
  • Phone: 703-534-2445
  • Fax: 703-538-5575
Mailing address:
  • Phone: 703-534-2445
  • Fax: 703-538-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number0101023974
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: