Provider Demographics
NPI:1821066358
Name:LANGSTON, BERNARD LEROY III (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:LEROY
Last Name:LANGSTON
Suffix:III
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 1:2930 HOLDEN BEACH RD SW
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-5702
Mailing Address - Country:US
Mailing Address - Phone:910-842-5991
Mailing Address - Fax:910-842-5994
Practice Address - Street 1:2930 HOLDEN BEACH RD SW
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-5702
Practice Address - Country:US
Practice Address - Phone:910-842-5991
Practice Address - Fax:910-842-5994
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8950904Medicaid
NC20302YKMedicare PIN
NC8950904Medicaid