1588006100 NPI number — RICHARD G. LANGELLOTTI, OD

Table of content: (NPI 1588006100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588006100 NPI number — RICHARD G. LANGELLOTTI, OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD G. LANGELLOTTI, OD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1588006100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2310 FINLEY RIDGE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27615-4047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-924-6147
Provider Business Mailing Address Fax Number:
252-822-0033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 EASTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27856-1814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-291-3939
Provider Business Practice Location Address Fax Number:
252-822-0033
Provider Enumeration Date:
07/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LANGELLOTTI
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
GREGORY
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
919-924-6147

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1667 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: 1667 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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