Provider Demographics
NPI:1043208374
Name:PEGRAM, LANGDON (MD)
Entity Type:Individual
Prefix:
First Name:LANGDON
Middle Name:
Last Name:PEGRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1652
Mailing Address - Country:US
Mailing Address - Phone:412-741-8700
Mailing Address - Fax:412-741-3710
Practice Address - Street 1:701 BROAD ST
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1652
Practice Address - Country:US
Practice Address - Phone:412-741-8700
Practice Address - Fax:412-741-3710
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063048L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F80267Medicare UPIN