Provider Demographics
NPI:1891808010
Name:HAITH, L'TANYA A (MD)
Entity type:Individual
Prefix:
First Name:L'TANYA
Middle Name:A
Last Name:HAITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21770 FDR BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653
Mailing Address - Country:US
Mailing Address - Phone:301-863-6661
Mailing Address - Fax:301-866-9189
Practice Address - Street 1:21770 FDR BOULEVARD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653
Practice Address - Country:US
Practice Address - Phone:301-863-6661
Practice Address - Fax:301-866-9189
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010425442084P0800X, 2084P0804X
MDD691872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2604103891OtherBCBS OF MICHIGAN
MI2604103891OtherBCBS OF MICHIGAN
MI0P225900001Medicare ID - Type Unspecified