Provider Demographics
NPI:1043271638
Name:LANGSDORF, RICHARD ALLEN (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:LANGSDORF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 LUTZ AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646
Mailing Address - Country:US
Mailing Address - Phone:330-854-6961
Mailing Address - Fax:330-854-2327
Practice Address - Street 1:4792 MUNSON ST NW
Practice Address - Street 2:HUMAN DEVELOPMENT & COUNSELLING ASSOC INC
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3630
Practice Address - Country:US
Practice Address - Phone:330-494-4636
Practice Address - Fax:330-494-5861
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34001967208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0236284Medicaid
LA0787151Medicare ID - Type Unspecified
OH0236284Medicaid