Provider Demographics
NPI:1255315081
Name:AMIR, ABDUL LATIF (MD)
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:LATIF
Last Name:AMIR
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 1:1000 BOULDERS PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5515
Mailing Address - Country:US
Mailing Address - Phone:804-591-3134
Mailing Address - Fax:804-282-1487
Practice Address - Street 1:6600 W BROAD ST STE 300
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1710
Practice Address - Country:US
Practice Address - Phone:804-320-4243
Practice Address - Fax:804-282-1487
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236604207R00000X, 207RH0002X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1255315081Medicaid
VA302011OtherANTHEM BCBS
VA139451OtherANTHEM
VAP00136200OtherMEDICARE RR
VA10130930Medicaid
VAP00601104OtherMEDICARE RAILROAD
VAP00136200OtherMEDICARE RR
VA139451OtherANTHEM
VA10130930Medicare PIN