Provider Demographics
NPI:1376570515
Name:LANGLEY, MICHAEL JOHN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:LANGLEY
Suffix:
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:PO BOX 2989
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910
Mailing Address - Country:US
Mailing Address - Phone:843-706-2255
Mailing Address - Fax:843-706-2257
Practice Address - Street 1:29 PLANTATION PARK DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910
Practice Address - Country:US
Practice Address - Phone:843-706-2255
Practice Address - Fax:843-706-2257
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038939208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACF8401OtherRAILROAD MEDICARE
VA7531699Medicaid
VA340000283Medicare ID - Type Unspecified
VA0196190004Medicare NSC
NC340000669Medicare PIN
VACF8401OtherRAILROAD MEDICARE
VAE50040Medicare UPIN