Provider Demographics
NPI:1043323058
Name:LANGILLE, DAVID KC (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KC
Last Name:LANGILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 ELSINORE PL STE 200
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1457
Mailing Address - Country:US
Mailing Address - Phone:513-834-7063
Mailing Address - Fax:
Practice Address - Street 1:101 N LYNNHAVEN RD
Practice Address - Street 2:SUITE100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7523
Practice Address - Country:US
Practice Address - Phone:757-264-9957
Practice Address - Fax:757-963-0444
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043050207RA0401X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900447Medicaid
251490OtherMAMSI/MDIPA
VA010146135Medicaid
9300570OtherOPTIMUM CHOICE
93215OtherOPTIMA
P00201468OtherMEDICARE RAILROAD
067TTOtherBLUE CROSS BLUE SHIELD NC
082480OtherBLUE CROSS BLUE SHIELD VA
007152T83Medicare ID - Type Unspecified
VA010146135Medicaid