Individual
MAURICE TREVELLE LATHAM SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
928 SUMMERSIDE CT, VIRGINIA BEACH, VA 23456-6373
(757) 927-2325
Mailing address
928 SUMMERSIDE CT, VIRGINIA BEACH, VA 23456-6373
(757) 927-2325
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
T62676783
VA
Other
Enumeration date
06/05/2018
Last updated
01/08/2019
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