Provider Demographics
NPI:1023546058
Name:LANGAT, PAUL KIPROTICH
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:KIPROTICH
Last Name:LANGAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 OCEAN AVE APT 315
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-2672
Mailing Address - Country:US
Mailing Address - Phone:857-413-9238
Mailing Address - Fax:
Practice Address - Street 1:230 REVERE ST APT 2
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4603
Practice Address - Country:US
Practice Address - Phone:857-413-9238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-04
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2304081163W00000X
MAAG07230203363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse