1083287460 NPI number — ROSALIND M LANGSTON CPT

Table of content: ROSALIND M LANGSTON CPT (NPI 1083287460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083287460 NPI number — ROSALIND M LANGSTON CPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGSTON
Provider First Name:
ROSALIND
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083287460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9461 HAMPTON DR APT 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46322-3611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
192-926-5182
Provider Business Mailing Address Fax Number:
219-533-4119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9461 HAMPTON DR APT 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46322-3611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
192-926-5182
Provider Business Practice Location Address Fax Number:
219-533-4119
Provider Enumeration Date:
07/22/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 202K00000X , with the licence number:  20-0164R10 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)