Provider Demographics
NPI:1184339350
Name:LANGSTON, MARTINA M (ADMIN)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:M
Last Name:LANGSTON
Suffix:
Gender:F
Credentials:ADMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-4800
Mailing Address - Country:US
Mailing Address - Phone:757-776-9686
Mailing Address - Fax:757-765-7012
Practice Address - Street 1:100 7TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-4800
Practice Address - Country:US
Practice Address - Phone:757-776-9686
Practice Address - Fax:757-765-7012
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-233091251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA300017514200001Medicaid