Healthcare Provider Details

I. General information

NPI: 1619502028
Provider Name (Legal Business Name): KAISER GARTLAND LAHM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NEALY RD
JBLE - LANGLEY AFB VA
23665
US

IV. Provider business mailing address

2025 GLENN MITCHELL DR
VIRGINIA BEACH VA
23456-0178
US

V. Phone/Fax

Practice location:
  • Phone: 757-764-2321
  • Fax:
Mailing address:
  • Phone: 757-507-4123
  • Fax: 757-716-3976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0102206918
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102206918
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: