MEDICARE: MR. DUKE T. LAHA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	0110001025	VA

General Provider Information

NPI Number	:	1780659961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUKE T. LAHA PA-C

Provider Business Mailing Address
First Line	:	3341 EDINBURGH DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-5750
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 LYNNHAVEN PKWY
Second Line	:	STE 201
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-1492
Country	:	US
Telephone Number	:	757-314-8916
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/08/2007

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