Provider Demographics
NPI:1407864713
Name:LANGEFELD, MARK STEPHEN (PA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:LANGEFELD
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 1:7 VANDERBILT PARK DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1700
Mailing Address - Country:US
Mailing Address - Phone:828-255-7776
Mailing Address - Fax:828-255-8794
Practice Address - Street 1:7 VANDERBILT PARK DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1700
Practice Address - Country:US
Practice Address - Phone:828-255-7776
Practice Address - Fax:828-255-8794
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101004363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2742548AMedicare ID - Type Unspecified
NCR35721Medicare UPIN