Provider Demographics
NPI:1659472827
Name:LANGHAM, ERNEST JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:JAMES
Last Name:LANGHAM
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 1:491 30TH ST SUITE #201
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-836-2122
Mailing Address - Fax:510-836-3773
Practice Address - Street 1:491 30TH ST SUITE #201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-836-2122
Practice Address - Fax:510-836-3773
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29049207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180026021OtherRAILROAD MEDICARE
CA00C290490Medicaid
CA00C290490Medicare PIN
180026021OtherRAILROAD MEDICARE
CA0449530001Medicare NSC