Provider Demographics
NPI:1851620546
Name:DR. MONIQUE Y LANGSTON & ASSOCIATES P A
Entity Type:Organization
Organization Name:DR. MONIQUE Y LANGSTON & ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LANGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-263-4400
Mailing Address - Street 1:1616 FOREST DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1019
Mailing Address - Country:US
Mailing Address - Phone:410-263-4400
Mailing Address - Fax:410-268-5548
Practice Address - Street 1:1616 FOREST DR
Practice Address - Street 2:SUITE 1
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1019
Practice Address - Country:US
Practice Address - Phone:410-263-4400
Practice Address - Fax:410-268-5548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0047494207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG17477Medicare UPIN
173736Medicare PIN