Provider Demographics
NPI:1336132737
Name:LANGLEY, CHARLES PITMAN III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:PITMAN
Last Name:LANGLEY
Suffix:III
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 1:608 W KING ST
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3373
Mailing Address - Country:US
Mailing Address - Phone:704-734-5129
Mailing Address - Fax:704-730-9536
Practice Address - Street 1:608 W KING ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3373
Practice Address - Country:US
Practice Address - Phone:704-734-5129
Practice Address - Fax:704-730-9536
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21288207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8950974Medicaid
NC2064242Medicare PIN
NC8950974Medicaid
C87543Medicare UPIN