Provider Demographics
NPI:1790878320
Name:LANGLOIS, GERARD A (PA)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:A
Last Name:LANGLOIS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:CARDIAC SURGICAL ASSOCIATES OF WESTERN NE
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-0906
Mailing Address - Country:US
Mailing Address - Phone:508-595-0531
Mailing Address - Fax:508-829-5367
Practice Address - Street 1:759 CHESTNUT ST.
Practice Address - Street 2:CARDIAC SURGICAL ASSOCIATES OF WESTERN NEW ENGLAND
Practice Address - City:SPRINGFIELD
Practice Address - State:CT
Practice Address - Zip Code:01107
Practice Address - Country:US
Practice Address - Phone:413-794-5550
Practice Address - Fax:413-794-4212
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT471363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP0123Medicare ID - Type Unspecified
S24117Medicare UPIN