Provider Demographics
NPI:1053509067
Name:LANGSAM, STACEY M (DO)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:M
Last Name:LANGSAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 LITCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6669
Mailing Address - Country:US
Mailing Address - Phone:860-489-5068
Mailing Address - Fax:860-489-3725
Practice Address - Street 1:538 LITCHFIELD ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6669
Practice Address - Country:US
Practice Address - Phone:860-489-5068
Practice Address - Fax:860-489-3725
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2447351208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT049221OtherSTATE LICENSE
NY244735OtherMEDICAL LICENSE NUMBER