Provider Demographics
NPI:1154394690
Name:LATIF, NAEEM (MD)
Entity type:Individual
Prefix:
First Name:NAEEM
Middle Name:
Last Name:LATIF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 HIGHLANDS DR STE 205
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7507
Mailing Address - Country:US
Mailing Address - Phone:717-625-5850
Mailing Address - Fax:
Practice Address - Street 1:1575 HIGHLANDS DR
Practice Address - Street 2:SUITE 205
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7507
Practice Address - Country:US
Practice Address - Phone:717-625-5850
Practice Address - Fax:717-625-0137
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424153207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0028055-00Medicaid
PA1010592010001Medicaid
PA50041983OtherCAPITAL BLUE CROSS
PA0001627495OtherBLUE SHIELD
PA0001627495OtherBLUE SHIELD
FLDQ353ZMedicare PIN
FLDQ353ZMedicare PIN