Provider Demographics
NPI:1053838334
Name:LANGWASSER, CHRISTIAN MICAH (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:MICAH
Last Name:LANGWASSER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-366-8030
Mailing Address - Fax:614-366-4545
Practice Address - Street 1:2501 N ORANGE AVE STE 401
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4644
Practice Address - Country:US
Practice Address - Phone:407-303-7283
Practice Address - Fax:407-303-0473
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008444363A00000X
OH50.005304RX363A00000X
FLPA9117193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0250023Medicaid