Provider Demographics
NPI:1437186152
Name:LANGWORTH-BREWER, RITA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:MARIE
Last Name:LANGWORTH-BREWER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:RITA
Other - Middle Name:M
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3729 WILLOW STONE LN
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3433
Mailing Address - Country:US
Mailing Address - Phone:845-234-2630
Mailing Address - Fax:
Practice Address - Street 1:1520 SUNDAY DR STE 309
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5254
Practice Address - Country:US
Practice Address - Phone:919-354-7077
Practice Address - Fax:919-354-7075
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004184363AS0400X
NC001002896363AS0400X
NC0010-02896363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S84017Medicare UPIN
NY0F40032651Medicare ID - Type Unspecified