Provider Demographics
NPI:1083287460
Name:LANGSTON, ROSALIND M (CPT)
Entity Type:Individual
Prefix:
First Name:ROSALIND
Middle Name:M
Last Name:LANGSTON
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9461 HAMPTON DR APT 12
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3611
Mailing Address - Country:US
Mailing Address - Phone:192-926-5182
Mailing Address - Fax:219-533-4119
Practice Address - Street 1:9461 HAMPTON DR APT 12
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3611
Practice Address - Country:US
Practice Address - Phone:192-926-5182
Practice Address - Fax:219-533-4119
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20-0164R10202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology