Provider Demographics
NPI:1063522290
Name:LATKIN, PETER C (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:LATKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6201 LEESBURG PIKE
Mailing Address - Street 2:#300
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044
Mailing Address - Country:US
Mailing Address - Phone:703-534-2445
Mailing Address - Fax:703-538-5575
Practice Address - Street 1:6201 LEESBURG PIKE
Practice Address - Street 2:#300
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044
Practice Address - Country:US
Practice Address - Phone:703-534-2445
Practice Address - Fax:703-538-5575
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101023974207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6756166Medicaid
VA6756166Medicaid
VA168338Medicare PIN