Provider Demographics
NPI:1780064501
Name:LATHAM, CHARLES RILEY (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RILEY
Last Name:LATHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1088 LONDON LINKS DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4662
Mailing Address - Country:US
Mailing Address - Phone:434-534-6868
Mailing Address - Fax:434-534-8808
Practice Address - Street 1:1088 LONDON LINKS DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4662
Practice Address - Country:US
Practice Address - Phone:434-534-6868
Practice Address - Fax:434-534-8808
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-06
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102205093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA207Q00000XOtherFAMILY MEDICINE