Provider Demographics
NPI:1225020688
Name:LAVIGNE-LANGENSTEIN, KERI MARIE (MD)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:MARIE
Last Name:LAVIGNE-LANGENSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:MARC J MEDWAY MD PC
Mailing Address - City:GWYNEDD VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19437-0602
Mailing Address - Country:US
Mailing Address - Phone:215-542-7260
Mailing Address - Fax:215-542-1012
Practice Address - Street 1:7600 CENTRAL AVE
Practice Address - Street 2:MARC J MEDWAY MD PC
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2442
Practice Address - Country:US
Practice Address - Phone:215-728-3736
Practice Address - Fax:215-728-3354
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD058349L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1122995OtherKEYSTONE MERCY
PA2Y1545OtherPHS HEALTH PLAN
PA2438725OtherAETNA US HEALTH
PA01588594Medicaid
PA0961554000OtherKEYSTONE HEALTH AMER HEAL
PA157681MD058349LOtherHEALTH PARTNERS
PA1122995OtherKEYSTONE MERCY
PA2438725OtherAETNA US HEALTH